Blood Transfusion

Background Current risk-stratification systems for patients with acute upper-gastrointestinal bleeding discriminate between patients at high or low risks of dying or rebleeding. We therefore developed and prospectively validated a risk score to identify a patient's need for treatment. Methods Our first study used data from 1748 patients admitted for upper-gastrointestinal haemorrhage. By logistic regression, we derived a risk score that predicts patients' risks of needing blood transfusion or intervention to control bleeding, rebleeding, or dying. From this score, we developed a simplified fast-track screen for use at initial presentation. In a second study, we prospectively validated this score using receiver operating characteristic (ROC) curves-a measure of the validity of a scoring system-and 2 goodness-of-fit testing with data from 197 patients. We also validated the quicker screening tool. Findings We calculated risk scores from patients' admission haemoglobin, blood urea, pulse, and systolic blood pressure, as well as presentation with syncope or melaena, and evidence of hepatic disease or cardiac failure. The score discriminated well with a ROC curve area of 0•92 (95% CI 0•88-0•95). The score was well calibrated for patients needing treatment (p=0•84). Interpretation Our score identified patients at low or high risk of needing treatment to manage their bleeding. This score should assist the clinical management of patients presenting with upper-gastrointestinal haemorrhage, but requires external validation.

Various adsorption techniques are available to remove serum autoantibodies and subsequently detect the underlying alloantibody in previously transfused patients with autoimmune haemolytic anaemia. We planned to establish a suitable adsorption technique in our transfusion service which can remove all autoantibodies and detect underlying alloantibodies rapidly, cheaply and effectively. We evaluated 71 direct antiglobulin test-reactive patients with warm AIHA over a period of 20 months. Twenty-three of these 71 patients who had a previous history of blood transfusion or pregnancy and were confirmed carriers of autoantibodies (indirect antiglobulin test-reactive) were considered for the adsorption study. Depending on the adequacy of samples, history of blood transfusion and severity of anaemia either autoadsorption or alloadsorption or both using polyethylene glycol (PEG) or low ionic strength saline (LISS)-papain were performed. Underlying alloantibodies were detected in 7 of the 23 pa...

Severe anemia is a leading indication for blood transfusion and a major cause of hospital admission and mortality in African children. Failure to initiate blood transfusion rapidly enough contributes to anemia deaths in sub-Saharan Africa. This article examines delays in accessing blood and outcomes in transfused children in Kenyan hospitals. Children admitted with nonsurgical conditions in 10 Kenyan county hospitals participating in the Clinical Information Network who had blood transfusion ordered from September 2013 to March 2016 were studied. The delay in blood transfusion was calculated from the date when blood transfusion was prescribed to date of actual transfusion. Five percent (2,875/53,174) of admissions had blood transfusion ordered. Approximately half (45%, 1,295/2,875) of children who had blood transfusion ordered at admission had a documented hemoglobin < 5 g/dl and 36% (2,232/6,198) of all children admitted with a diagnosis of anemia were reported to have hemoglobin < 5 g/dL. Of all the ordered transfusions, 82% were administered and documented in clinical records, and three-quarters of these (75%, 1,760/2,352) were given on the same day as ordered but these proportions varied from 71% to 100% across the 10 hospitals. Children who had a transfusion ordered but did not receive the prescribed transfusion had a mortality of 20%, compared with 12% among those transfused. Malariaassociated anemia remains the leading indication for blood transfusion in acute childhood illness admissions. Delays in transfusion are common and associated with poor outcomes. Variance in delay across hospitals may be a useful indicator of health system performance. BACKGROUND Severe anemia mostly attributable to malaria is a leading indication for blood transfusion and an important cause of hospital admission and mortality in African children. 1-6 The World Health Organization (WHO) has provided guidelines to inform clinical decisions on transfusion linked to hemoglobin level. 7-10 On the basis of these guidelines, urgent blood transfusion is recommended for children with severe malaria and hemoglobin level < 5 g/dL if they are in respiratory distress. 11-13 Although these guidelines can be lifesaving, 14-17 adherence to its recommendations is poor, 18 and when used, there still might be need for retransfusion. Despite clear transfusion policies and clinical guideline recommendations, the inability to initiate blood transfusion rapidly enough to save lives has been identified as a contributing factor to anemia deaths in sub-Saharan Africa. 14,19 Considerable investments have been made in the blood transfusion services in Kenya over recent years to provide regional blood banks and improved screening to reduce possible risk of acquiring transfusion-transmitted infections. 12,20,21 Prior to nationwide efforts to improve transfusion services, significant health system challenges existed in availability and delivery of blood for transfusion, 21-24 and this often made urgent transfusion almost impossible. 21 At the patient level, prior audits of care for malaria-associated anemia admissions have reported problems with ordering and documentation of basic laboratory investigations. Furthermore, hemoglobin measurement and evidence of inappropriate transfusion practices have also been observed, 16,21,24 and such audits, however, are often limited in scope over time or place. This study sought to examine the ability of clinicians to access blood when needed in Kenya after efforts to

In 20 patients undergoing coronary artery bypass grafting, we studied prospectively systemic blood activation, blood loss, and the need for donor blood when using an extracorporeal circuit equipped at random with one of two different venous reservoirs. In 10 patients we used an open venous reservoir system (ORS) consisting of a hard shell venous reservoir with an integral cardiotomy filter, and in 10 patients we used a closed reservoir system consisting of a collapsible venous reservoir and separate cardiotomy reservoir. Concentrations of complement 3a, elastase, thromboxane B2, and fibrin degradation products showed a biphasic course, especially in ORS patients. During bypass, we observed a first peak of levels of complement 3a, thromboxane B2, fibrin degradation products, and elastase, which was higher in ORS patients than in patients with the closed system, because their blood continuously contacted the foreign materials of the filter and air in the open reservoir, which was avoided in the closed reservoir. Intensive blood-foreign material contact also caused the highest (p < 0.05) hemolysis in ORS patients. The larger amount of hemolytic products in ORS patients theoretically resulted in a temporary decrease in capacity of their Kupffer cells to clear endotoxin released after aortic declamping. This theory might explain the significantly (p < 0.01) higher second peak of activated products after declamping that was observed in ORS patients. Due to increased blood activation, the largest (p < 0.001) amount of shed blood loss, greatest (p < 0.05) need for colloid-crystalloid infusion, and largest (not significant) need for donor blood were found in ORS patients (0.8 +/- 0.4 versus 0.2 +/- 0.2 units of packed cells).(ABSTRACT TRUNCATED AT 250 WORDS)

Patients and Methods Cirrhotic patients with acute esophageal variceal bleeding that was initially controlled with emergency sclerotherapy and in whom a hemodynamic evaluation could be performed within the first 24 hours of admission, were considered for inclusion in this study. All patients were admitted to our hospital with hematemesis and/or melena. Diagnostic endoscopy was performed between 1 and 5 hours later, as soon as safely possible after initial resuscitation. Variceal hemorrhage was defined when endoscopy showed active hemorrhage

In 2 siblings with recurring attacks of thrombotic thrombocytopenic purpura, platelet aggregation was found to be decreased during attacks. In contrast with reported observations in other patients, aggregation was found decreased also in symptom-free periods. ATP/ADP ratio in platelet rich plasma was normal. The cause of decreased aggregation was not uraemia, alcohol or drugs. In a healthy sister, platelet aggregation induced by A D P was subnormal. The attacks in 1 of the patients responded to infusion of fresh frozen plasma.

Seven Italian centers reported data on survival, causes of death and appearance of complications in patients with thalassemia major. The interactions between gender, birth cohort, complications, and ferritin on survival and complications were analyzed. Survival after the first decade was studied for 977 patients born since 1960 whereas survival since birth and complication appearance was studied for the 720 patients born after 1970. Better survival was demonstrated for patients born in more recent years (p&lt;0.00005) and for females (p=0.0003); 68% of the patients are alive at the age of 35 years. In the entire population 67% of the deaths were due to heart disease. There was a significant association between birth cohort and complication-free survival (p&lt;0.0005). The prevalence of complications was: heart failure 6.8%, arrhythmia 5.7%, hypogonadism 54.7%, hypothyroidism 10.8%, diabetes 6.4%, HIV infection 1.7%, and thrombosis 1.1%. Lower ferritin levels were associated with a l...

OBJECTIVE: This study was undertake to determine risk factors for adverse maternal outcomes among women with HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome. STUDY DESIGN: Maternal medical records of pregnancies complicated by HELLP syndrome managed between July 1, 1992, and April 30, 1999, were reviewed. Risk factors evaluated included maternal age, parity, race, previous preeclampsia, chronic hypertension, gestational age at diagnosis, mean arterial blood pressure, nadir blood platelet count (<50,000 cells/µL vs ≥50,000 cells/µL), and peak serum levels of aspartate aminotransferase and lactate dehydrogenase. Maternal outcome variables analyzed included eclampsia, abruptio placentae, disseminated intravascular coagulopathy, pulmonary edema, pleural effusion, ascites, acute renal failure, liver hematoma, need for transfusion of blood products, cesarean delivery, and death. Statistical analysis was performed with the Student t test, the χ 2 test, and logistic regression analysis. RESULTS: A total of 183 women with HELLP syndrome were studied. Eclampsia was present in 6%, abruptio placentae was present in 10%, and disseminated intravascular coagulopathy was present in 8%. Fortyone women (22%) required transfusion of blood products. Incidence of eclampsia significantly decreased with increasing gestational age, from 16% at ≤28 weeks' gestation to 3% at >32 weeks' gestation (P < .05) and was higher among African American patients than among white patients (12% vs 3%; P < .05). Logistic regression analysis showed an independent relationship between eclampsia and race (P < .05). Incidence of abruptio placentae was higher among women with previous preeclampsia than among women without this clinical history (26% vs 5%; P < .05). Disseminated intravascular coagulopathy was significantly associated with abruptio placentae (P < .0001) and acute renal failure (P < .0001). A nadir platelet count of <50,000/µL, a peak serum aspartate aminotransferase level of >150 U/L, and a peak serum lactate dehydrogenase level of >1400 U/L were not independent risk factors for adverse outcome. CONCLUSIONS: Among women with HELLP syndrome, African American race is a risk factor for eclampsia. Both acute renal failure and abruptio placentae are associated with disseminated intravascular coagulopathy. Laboratory parameters of HELLP syndrome are not independent risk factors for adverse maternal outcome. (Am J Obstet Gynecol 2000;183:444-8.)

Current risk-stratification systems for patients with acute upper-gastrointestinal bleeding discriminate between patients at high or low risks of dying or rebleeding. We therefore developed and prospectively validated a risk score to identify a patient&amp;#39;s need for treatment. Our first study used data from 1748 patients admitted for upper-gastrointestinal haemorrhage. By logistic regression, we derived a risk score that predicts patients&amp;#39; risks of needing blood transfusion or intervention to control bleeding, rebleeding, or dying. From this score, we developed a simplified fast-track screen for use at initial presentation. In a second study, we prospectively validated this score using receiver operating characteristic (ROC) curves--a measure of the validity of a scoring system--and chi2 goodness-of-fit testing with data from 197 patients. We also validated the quicker screening tool. We calculated risk scores from patients&amp;#39; admission haemoglobin, blood urea, pulse, and systolic blood pressure, as well as presentation with syncope or melaena, and evidence of hepatic disease or cardiac failure. The score discriminated well with a ROC curve area of 0.92 (95% CI 0.88-0.95). The score was well calibrated for patients needing treatment (p=0.84). Our score identified patients at low or high risk of needing treatment to manage their bleeding. This score should assist the clinical management of patients presenting with upper-gastrointestinal haemorrhage, but requires external validation.

Although the risk of transfusion-transmitted infections today is lower than ever, the supply of safe blood products remains subject to contamination with known and yet to be identified human pathogens. Only continuous improvement and implementation of donor selection, sensitive screening tests and effective inactivation procedures can ensure the elimination, or at least reduction, of the risk of acquiring transfusion transmitted infections. In addition, ongoing education and up-to-date information regarding infectious agents that are potentially transmitted via blood components is necessary to promote the reporting of adverse events, an important component of transfusion transmitted disease surveillance. Thus, the collaboration of all parties involved in transfusion medicine, including national haemovigilance systems, is crucial for protecting a secure blood product supply from known and emerging blood-borne pathogens.

Cardiopulmonary bypass (CPB) is associated with morbidity and mortality. To reduce its adverse effect modified ultrafiltration is being increasingly employed. This study is planned to evaluate the benefits of modified ultrafiltration (MUF) in adult cardiac surgery. Eighty consecutive patients presenting to adult cardiac surgery as elective case were enrolled. These patients were randomly divided in to two groups. MUF group which received modified ultrafiltration after separation from CPB and control group which did not receive modified ultrafiltration. Postoperative mediastinal and chest drainage in 24 hrs, blood products requirement, reopening, ICU stay, and mortality in 30 days were recorded. These variables were compared between MUF group and control group. Forty patients were randomized to control group and 40 in MUF group. Mean age was 51.15 ± 8.90 in control group as compared to 46.95 ± 13.24 MUF group (p = 0.1). Out of 40 patients in control group 7 (17.5%) were female while ...

Background: Clinical investigations have shown prognostic heterogeneity within the non-Hodgkin's lymphomas (NHLs) according to histology, but few descriptive studies have considered NHLs by subgroup. Our purpose is to assess the demographic patterns and any notable increases in population-based rates of different histologic subgroups of NHL. Methods: Using data collected by the Surveillance, Epidemiology, and End Results Program of the National Cancer Institute, we calculated incidence rates for the major clinicopathologic categories of NHL by age, race, sex, geographic area, and time period. Results: Among the 60 057 NHL cases diagnosed during the period from 1978 through 1995, total incidence (per 100 000 person-years) was 17.1 and 11.5 among white males and females, respectively, and 12.6 and 7.4 among black males and females, respectively. However, rates for follicular NHLs were two to three times greater among whites than among blacks, with little sex variation. Blacks demonstrated much higher incidence than whites for peripheral T-cell NHL, with the incidence rates higher in males than in females. For other NHL subgroups, the incidence rates for persons less than 60 years of age were generally higher among males than among females, with little racial difference; at older ages, the rates were higher among whites than among blacks, with little sex difference. Highgrade NHL was the most rapidly rising subtype, particularly among males. Follicular NHL increased more rapidly in black males than in the other three race/sex groups. Overall, the broad categories of small lymphocytic, follicular, diffuse, high-grade, and peripheral T-cell NHL emerged as distinct entities with specific age, sex, racial, temporal, and geographic variations in rates. Conclusions: Findings from our large, population-based study reveal differing demographic patterns and incidence trends according to histologic group. Future descriptive and analytic investigations should evaluate NHL risks according to subtype, as defined by histology and new classification criteria. [

Venous thromboembolism (VTE) is a significant cause of mortality in patients with lung cancer. Despite the availability of a wide range of anticoagulants to help prevent thrombosis, thromboprophylaxis in ambulatory patients is a challenge due to its associated risk of haemorrhage. As a result, anticoagulation is only recommended in patients with a relatively high risk of VTE. Efforts have been made to develop predictive models for VTE risk assessment in cancer patients, but the availability of a reliable predictive model for ambulate patients with lung cancer is unclear. We have analysed the latest information on this topic, with a focus on the lung cancer-related risk factors for VTE, and risk prediction models developed and validated in this group of patients. The existing risk models, such as the Khorana score, the PROTECHT score and the CONKO score, have shown poor performance in external validations, failing to identify many high-risk individuals. Some of the newly developed an...

Objective To assess the most commonly employed diagnostic indicators of severe maternal morbidity (obstetric near-miss). Methods Review of the literature from January 1989 to August 2008. Results Fifty-one manuscripts met the eligibility criteria, and 96 indicators were utilized at least once. Admission to intensive care unit (n = 28 studies) was the indicator most frequently utilized, followed by eclampsia and hemorrhage (n = 27), blood transfusion (n = 26) and emergent hysterectomy (n = 24). Conclusion Considering these Wndings, a trial version of a 13-item instrument for diagnosing obstetric near-miss is proposed. It includes the indicators eclampsia, severe hypertension, pulmonary edema, cardiac arrest, obstetrical hemorrhage, uterine rupture, admission to intensive care unit, emergent hysterectomy, blood transfusion, anesthetic accidents, urea >15 mmol/l or creatinine >400 mmol/l, oliguria (<400 ml/24 h) and coma. Further studies should focus on consensual deWnitions for these indicators and evaluate the psychometric proprieties of this trial version.

The purpose of this study was to compare the efficacy of topical Tranexamic Acid (TXA) versus Intravenous (IV) Tranexamic Acid for reduction of blood loss following primary total knee arthroplasty (TKA). This prospective randomized study involved 89 patients comparing topical administration of 2.0 g TXA, versus IV administration of 10 mg/kg. There were no differences between the two groups with regard to patient demographics or perioperative function. The primary outcome measure, perioperative change in hemoglobin level, showed a decrease of 3.06 ± 1.02 in the IV group and 3.42 ± 1.07 in the topical group (P = 0.108). There were no statistical differences between the groups in preoperative hemoglobin level, lowest postoperative hemoglobin level, or total drain output. One patient in the topical group required blood transfusion (P = 0.342). Based on our study, topical Tranexamic Acid has similar efficacy to IV Tranexamic Acid for TKA patients.

The exact number of leukocytes remaining in 'leukocyte-free' red cell and platelet concentrates cannot be measured by standard methods. We have therefore developed methods to harvest all the leukocytes from blood components. The leukocytes were then counted and identified using monoclonal antibodies. The leukocyte-free red cell concentrates were prepared by combining buffy coat removal and filtration through a Cellselect filter. The mean number of leukocytes per unit was 1 .Ox lo5. Most of the leukocytes were granulocytes and T cells. Only a few B cells or monocytes could be detected. Leukocyte-free platelets were prepared by filtering 4 units of PC through a cotton-wool (Imugard) filter. The mean number of leukocytes per PC unit was 0. 4~1 0~ of which 85-95Oh were T cells.

Background Efficient blood transfusion management presents an ongoing challenge for many trauma centers. We present the Emergency Transfusion Score (ETS), a measure that may allow important time and cost savings in the treatment of severely injured patients in the Emergency Room (ER). Methods The ETS includes the parameters low blood pressure, free fluid on ultrasound, clinical instability of the pelvic ring, age, admission from the scene, and trauma mechanism. An ETS C 3 indicates a transfusion probability of 5% and was set as the cut-off to order blood products (10 packed red blood cells [PRBC]/10 fresh frozen plasma [FFP]). Results A total of 481 patients requiring trauma team activation (ISS 18 ±18; 7/03-12/04) were prospectively included. The ETS was \ 3 in 306 patients (64%) and C 3 in 175 subjects (36%). Some 40 patients (8.3%) received blood (8 ± 8 PRBC) after 23 ± 9 min during ER treatment, and 39 of these patients had an ETS of C 3 (5.4 ± 1.5 points). Sensitivity of the ETS was 97.5%; specificity, 68%. Positive predictive value of the ETS was 0.222; negative predictive value, 0.998. Conclusions (1) The ETS is a safe and highly sensitive tool with which to detect severely injured patients in need of blood products. (2) The ETS is highly predictive for patients not in need of PRBC (negative predictive value 0.998) and helps to avoid unnecessary cross-matching and transport. (3) After implementation of the ETS, a sum of about 109,296 USD was saved per year by reducing the costs for crossmatching, transportation, and wasted blood products.

Unrelated hematopoietic stem cell transplantation (HSCT) is a recognized therapy for hematological diseases and over 8 million HLA-typed donors are ready to donate. Increased international exchanges and rapid requests through the Bone Marrow Donor Worldwide (BMDW) ask for standardized quality assurance. Since no such standards have been established to date, we tested a pilot program in order to evaluate donor availability and quality of HLA typing of the Swiss Registry.The 18500 donors of the registry have been analyzed by serology for HLA-AB and by molecular typing for HLA-DR. Through three successive annual quality control (QC) exercises, a total of 114 donor requests were sent to 13 blood transfusion centers responsible for donor recruitment asking for a blood sample. Donors were randomly selected according to recruitment periods (to homozygosity for HLA-A and/or -B antigens. An additional 80 frozen blood samples from the repository corresponding to the three periods (n ¼ 26) and to the 2001 period (n ¼ 54) were also included in the HLA study. HLA-AB typings were done by polymerase chain reaction-sequence specific primers (PCR-SSP) and all discrepancies were retyped. The results showed that 79 samples provided by 69.3% of the requested donors were received within 14 days, and 19 samples (16.7%) were received in 414 days. Altogether, an 86% rate of donor availability was observed, independent of the recruitment period. Among the requested donors, 16 (14%) were not available: for medical reasons (two), for personal reasons (eight), for loss (one), and for an unknown reason (five). The HLA-A/B DNA typing results of 166 homozygous and 12 heterozygous blood samples showed that 437/439 (99.5%) of the assigned A/B antigens were correct.

The application of blood conservation strategies to minimise or avoid allogeneic blood transfusion is seen internationally as a desirable objective. Bloodless surgery is a relatively new practice that facilitates that goal. However, the concept is either poorly understood or evokes negative connotations. Bloodless surgery is a term that has evolved in the medical literature to refer to a peri-operative team approach to avoid allogeneic transfusion and improve patient outcomes. Starting as an advocacy in the early 1960s, it has now grown into a serious practice being embraced by internationally respected clinicians and institutions. Central to its success is a coordinated multidisciplinary approach. It encompasses the peri-operative period with surgeons, anaesthetists, haematologists, intensivists, pathologists, transfusion specialists, pharmacists, technicians, and operating room and ward nurses utilising combinations of the numerous blood conservation techniques and transfusion alt...

Study Design. Retrospective case control study.Objective. To evaluate the hemostatic benefits of using a kaolin impregnated dressing during pediatric spinal deformity correction surgery.Summary of Background Data. Minimizing blood loss and transfusions are clear benefits for patient safety. A technique common in both severe trauma and combat medicine that has not been reported in the spine literature is wound packing with a kaolin impregnated haemostatic dressing.Methods. Estimated blood loss and transfusion amounts were analyzed in a total of 117 retrospectively identified cases. The control group included 65 patients (46F, 19M, 12.7±4.5 years, 10.2± 4.8 levels fused) who received standard operative care with gauze packing between June 2007 and March 2010. The treatment group included 52 patients (33F, 19M, 13.9±3.2 years, 10.4 ± 4.3 levels fused) who underwent intra-operative packing with QuikClot Trauma Pads (QCTP, Z-Medica Corporation) for all surgeries from July 2010 to August ...

Background-Low tidal volume ventilation for Acute Respiratory Distress Syndrome (ARDS) is a well accepted concept. However, controversy persists regarding the optimal ventilator settings for ventilated patients without ARDS. This study tested the hypothesis that ventilator settings influence the development of new ARDS. Methods-Retrospective analysis of patients from the MIMIC-II database who were mechanically ventilated for ≥48 hours between 2001 and 2005. Results-2583 patients required greater than 48 hrs of ventilation. Of 789 patients who did not have ARDS at admission, 152 (19%) went on to develop ARDS. Univariate analysis revealed high peak inspiratory pressure (PIP) (OR 1.53 per standard deviation, 95% confidence interval 1.28-1.84), increasing PEEP (OR 1.35 per SD, 95%CI 1.15-1.58) and tidal volume (OR 1.36 per SD, 95%CI 1.12-1.64) to be significant risk factors. Major non-ventilator risk factors for ARDS included sepsis, low pH, elevated lactate, low albumin, transfusion of packed red blood cells, transfusion of plasma, high net fluid balance, and low respiratory compliance. Multivariable logistic regression showed that peak pressure (OR 1.31 per SD, 95%CI 1.08-1.59), high net fluid balance (OR 1.3 per SD, 95%CI 1.09-1.56), transfusion of plasma (OR 1.26 per SD, 95%CI 1.07-1.49), sepsis (OR 1.57, 95%CI 1.00-2.45) and tidal volume (OR 1.29 per SD, 95%CI 1.02-1.52) were significantly associated with the development of ARDS. Conclusions-The associations between the development of ARDS and clinical interventions, including high airway pressures, high tidal volume, positive fluid balance and transfusion of blood products, suggests that ARDS may be a preventable complication in some cases.

supplementation in haemodialysis patients. No significant adverse reactions to iron therapy were observed. Background. The aim of this prospective study was to test a new protocol for iron supplementation in haemo-Key words: erythropoietin; ferritin; haemodialysis; iron; dialysis patients, as well as to assess the utility of intravenous different iron metabolism markers in common use and their 'target' values for the correction of iron deficiency. Methods. Thirty-three of 56 chronic haemodialysis patients were selected for long-term (6 months) i.v. Introduction iron therapy at 20 mg three times per week postdialysis based on the presence of at least one of the With the widespread utilization of rHuEpo in haemofollowing iron metabolism markers: percentage of dialysis, prolonged or chronic iron overload and transferrin saturation (%TSAT) <20%; percentage of haemosiderosis have almost disappeared. Eryhypochromic erythrocytes (%HypoE) >10% and thropoietin promotes the use of iron deposits in the serum ferritin (SF) <400 mg/l. Reasons for patient bone marrow, and consequently iron deficiency is a exclusion were active inflammatory or infectious disfrequent problem resulting in resistance to the full eases, haematological diseases, psychosis, probable effect of rHuEpo. It is well known that a negative iron iron overload (SF Á400 mg/l) and/or acute need of balance may occur-up to 2 g/year [1]-and it is not blood transfusion mostly due to haemorrhage and well established whether there is a compensatory change in renal replacement treatment. increase in intestinal absorption in haemodialysis Results. More than half (51.8%) of the patients of our patients when they are iron deficient [2-5]. Oral dialysis centre proved to have some degree of iron supplementation is plagued by poor patient adherence deficiency in spite of their regular oral iron due to frequent side-effects, and interference of other supplementation. At the start of the study the mean medication with the digestive absorption [6 ]. Several haemoglobin was 10.8 g/dl and increased after the 6 studies have demonstrated the utility of i.v. iron months of iron treatment to 12.8 g/dl (P<0.0001). supplementation in correcting anaemia and sparing The use of erythropoietin decreased from 118 rHuEpo [7-10]. However the multiple publications units/kg/week to 84 units/kg/week. The criterion for evaluating the criteria to detect and to treat patients iron supplementation with the best sensitivity/specifiwith iron deficiency and the several protocols adopted city relationship (100/87.9%) was ferritin <400 mg/l. to correct this situation clearly show that there is no Patients with ferritin <100 mg/l and those with ferritin consensus [11-18]. between 100 mg/l and 400 mg/l had the same increase We administered 20 mg iron i.v. post-dialysis on a in haemoglobin but other parameters of iron metabollong-term basis because it allows approximated conism were different between the two groups. tinuous availability of iron to be incorporated into Conclusions. Routine supplementation of iron in haemoglobin under the action of rHuEpo and allowed haemodialysis patients should be performed intraveneasy control to prevent the oversaturation of transferously. Target ferritin values should be considered indirin [19,20] and iron overload. vidually and the best mean haemoglobin values were We evaluated rHuEpo dose and haemoglobin during achieved at 6 months with a mean ferritin of 456 mg/l long-term i.v. iron therapy for 6 months and evaluated (variation from to 919 mg/l). The percentage of transthe best markers to monitor this therapy. Prior to this ferrin saturation, percentage of hypochromic erythrostudy, iron status was assessed on a 3-month basis by cytes and ferritin <100 mg/l, were not considered serum ferritin (SF) and the percentage of transferrin useful parameters to monitor routine iron saturation (%TSAT); iron supplementation was given orally as a routine and the i.v. route was reserved for

Many investigators have demonstrated the short-term and midterm efficacy of minimally invasive direct coronary artery bypass (MIDCAB). However, the influence of heparin dosing during MIDCAB on postoperative and immediate graft patency is less well defined. This report outlines our experience with MIDCAB employing a variety of heparinization protocols. The traditional MIDCAB approach was used in 152 patients who underwent single-vessel off-pump coronary artery bypass. Before the left internal mammary artery was divided, a 150-U/kg bolus of heparin sodium was given to 76 patients (group 1), and 300 U/kg was given to another 76 patients (group 2). Additional heparin was given during the procedures to maintain an activated clotting times of greater than 300 seconds for group 1 and greater than 400 seconds for group 2. On average, patients in group 1 required more boluses of heparin during treatment than patients in group 2. A larger standard deviation from the mean was observed for the ...

In assessing erythropoietic agents for chemotherapy-induced anemia, traditional single time-point end points (e.g., hematopoietic response [HR]) fail to reflect clinical benefits over the entire therapy course. Area under the hemoglobin change curve (Hb AUC) is introduced as an alternative measure, and its reliability, clinical significance, and superiority are assessed.

Haemovigilance was part of the reform of the French transfusion system. The haemovigilance network is now operational with approximately 4600 transfusion incidents reported annually. Immediate incidents observed within 8 days after transfusion account for 85 % of the reports. A cause cannot be identified in 41% of these, usually concerning minor clinical incidents with transient fever and /or shivers. An allergic reaction is described in 31% of transfusion reactions. Immunological conflicts account for 18% and bacteria associated transfusion reactions for 6%. The importance of bacteria associated transfusion reactions, the first identified cause of death associated with transfusion is one of the findings of haemovigilance. Improvement in the haemovigilance systems aims at obtaining better descriptions of transfusion incidents, standardisation of severity and imputability assessment and definitions of denominators such as the actual number of recipients. Delayed incidents will ultimately provide a true vision of post transfusion immunisation and infection The improvement of haemovigilance now considered as part of transfusion medicine practice is a continuous process. 01998 S. Karger AG, Basel 0042-9007/98/0746-044 1 S 1 5 .OO/O

Among patients undergoing coronary procedures, patients with coronary artery bypass grafts represent an important, high risk subgroup. Routine transradial approach may be successfully adopted in these patients to reduce access-site complications. However, transradial cannulation of the grafts may result technically demanding. In this article we discuss the specific technical issues and we present a series of tips and tricks which may facilitate angiography and interventions on both internal mammary and aorto-coronary grafts. © 2008 Wiley-Liss, Inc.

Background. The purpose of this study was to assess the impact of care guidelines for patients with isolated blunt splenic trauma on length of stay (LOS) and patient charges. Methods. We conducted a review of the hospital trauma registry and identified patients admitted with blunt splenic injury from 2000 to 2007. Splenic injury guidelines were initiated in November 2004. Patients with other major injuries were excluded. Patients were grouped according to their American Association for the Surgery of Trauma (AAST) splenic injury grade, I--V. Hospital LOS, intensive care unit (ICU) LOS, and patient charges before and after the guidelines were compared. Results. We identified 137 patients with isolated splenic injuries. Sixty-three patients were admitted before and 70 patients after implementation of the guidelines. ICU and hospital LOS were significantly decreased after the guidelines (ICU LOS, 1.35 days before, 0.80 after [P < .01]; and hospital LOS, 4.17 before, 3.27 after [P < .01]). When grouped by AAST grade, grade II injuries had a decrease in hospital LOS (4.5 before vs 2.29 after; P < .01) and ICU LOS (1.43 before vs 0.29 after; P < .01). Adjusted hospital charges showed no significant increase overall after the guideline implementation (mean hospital charges before $23,047 vs after, $24,116; P = .62). Conclusion. Implementing guidelines for the observation of blunt splenic injury decreased the overall hospital LOS and ICU LOS at our institution, but hospital charges remained the same. Trauma programs should institute splenic injury guidelines to reduce resources needed for the care of isolated splenic injuries. (Surgery 2009;146:787-93.) From the Division

Several blood transfusion filters designed to remove microemboli were evaluated for filtration and flow characteristics, as well as for hemolysis and for release of particulate debris from the filter. The Dacron wool filter, a depth filter, was superior at removing microemboli

Cardiology and cardiovascular surgery patients have historically been one of the sickest populations that physicians encounter. With the inherent compromise of the cardiac and/or respiratory system and the added complexity of a major surgical procedure, this patient group requires a demanding level of care. As innovations in the treatment of cardiac patients have prolonged life, we have encountered patients who require redo-redo-redo procedures. There has been a tremendous increase in the use of a wide variety of mechanical assist devices, transplantation procedures, robotic surgery, and hybrid approaches in which cardiac surgeons and cardiologists work in the same room on the same patient.

Cardiac surgery in Jehovah&#39;s Witnesses may be challenging during the operation and postoperative period given their refusal of blood products. The aim of this study was to document our center&#39;s experience with Jehovah&#39;s Witnesses undergoing major cardiac surgery and to compare surgical outcomes with a matched control group. We retrospectively reviewed the demographic, perioperative, and in-hospital postoperative data for 31 Jehovah&#39;s Witness patients undergoing surgery from 1991 to 2012 and compared findings with a control group of 62 patients of the same sex and age, who underwent the same type of operations in the same period. Early mortality, major in-hospital morbidity, laboratory findings, and hospital stays were compared between groups. Demographic data were similar between groups, except that more patients in the Jehovah&#39;s Witness group had extracardiac arteriopathy compared with controls (p = 0.04). There was no difference in predicted mortality, calculat...

Methods: In this study out of 380 planned off-pump coronary artery bypass procedures done between August 2002 to July 2006, 12 patients required emergency conversion, of which three patients were after haemodynamic collapse, and nine patients were semi elective conversions before haemodynamic collapse.

Introduction Gastrointestinal bleeding is a common life-threatening problem, causing significant mortality, costs and resource allocation. Its management requires a dynamic multidisciplinary approach that directs diagnostic and therapeutic priorities appropriately. Materials and methods Articles published within the past 15 years, related to gastrointestinal bleeding, were reviewed through MEDLINE search, in addition to current guidelines and standards. Results Decisions of ICU admission and blood transfusion must be individualized based on the extent of bleeding, hemodynamic profile and comorbidities of the patient and the risk of rebleeding. A secure airway may be required to optimize oxygenation and to prevent aspiration. Doses of induction agents must be reduced due to the changes in volume of distribution. Volume replacement is the cornerstone of resuscitation in profuse bleeding, but nontargeted aggressive fluid resuscitation must be avoided to allow clot formation and to prevent increased bleeding. Decision to give blood transfusion must be based on physiologic triggers rather than a fixed level of hemoglobin. Coagulopathy must be corrected and hypothermia avoided. Need for massive transfusion must be recognized as early as possible, and a 1:1:1 ratio of packed red blood cells, fresh frozen plasma and platelets is recommended to prevent dilutional coagulopathy. Tromboelastography can be used to direct hemostatic resuscitation. Transfusion related lung injury (TRALI) is a significant problem with a mortality rate approaching 40%. Prevention of TRALI is important in patients with gastrointestinal bleeding, especially among patients having end-stage liver disease. Preventive strategies include prestorage leukoreduction, use of male-only or never-pregnant donors and avoidance of long storage times. Management of gastrointestinal bleeding requires delicately tailoring resuscitation to patient needs to avoid nonspecific aggressive resuscitation. “Functional hemodynamic monitoring” requires recognition of indications and limitations of hemodynamic measurements. Dynamic indices like systolic pressure variation are more reliable predictors of volume responsiveness. Noninvasive methods of hemodynamic monitoring and cardiac output measurement need further verification in patients with gastrointestinal bleeding. Conclusions Management of gastrointestinal bleeding requires a dynamic multidisciplinary approach. The mentioned advances in management of hemorrhagic shock must be considered in resuscitation and monitoring of patients with GI bleeding.

BACKGROUND: Ligation of the significantly injured infrarenal inferior vena cava (IVC) is an accepted practice in the setting of damage control surgery. This is a report of inpatient management, outcomes, and long-term follow-up in 25 patients after IVC ligation.

Hemoglobin (Hb) Bristol-Alesha is caused by a GTG→ATG mutation at codon 67 in the Hb ␤ chain, resulting in abnormal ␤ globin chains with mutated molecules from normal ␤67 valine (Val) to ␤67 methionine (Met) or ␤67 aspartate (Asp). We describe a Japanese child with this rare hemoglobinopathy and a very unstable Hb molecule phenotype. The diagnosis of hemolytic anemia was made when the patient was 6 months of age. Development of marked splenomegaly necessitated red blood cell transfusions twice a month. After splenectomy when the patient was 4 years of age, laboratory findings of hemolytic anemia became more prominent. Specific abnormal Hb molecules initially were not detected, and the ␣/␤ globin synthesis ratio was abnormal at 2.22. After splenectomy, we identified the presence of abnormal ␤-globin chains with a ␤67Val:␤67Met:␤67Asp molecule ratio of 74:11:15. We speculate that the high fraction of the ␤67Met molecule in this patient, compared with that in previously reported cases, caused extreme Hb instability, which resulted in thalassemic hyperunstable hemoglobinopathy and very severe clinical findings.