Challenging the Interpretation of White Blood Cell Counts in Patients with Sepsis Following Packed Cell Transfusion.

Critically ill patients with sepsis often require packed cell transfusions (PCT). However, PCT may affect white blood cell (WBC) counts. We conducted a population-based retrospective cohort study to trace changes in WBC count following PCT in critically ill patients with sepsis. We included 962 patients who received one unit of PCT while hospitalized in a general intensive care unit, and 994 matched patients who did not receive PCT. We calculated the mean values of WBC count for the 24 h before and 24 h after PCT. Multivariable analyses using a mixed linear regression model were performed. The mean WBC count decreased in both groups, but more in the non-PCT group (from 13.9 × 109/L to 12.2 × 109/L versus 13.9 × 109/L to 12.8 × 109/L). A linear regression model showed a mean decrease of 0.45 × 109/L in WBC count over the 24 h following the start of PCT. Every 1.0 × 109/L increase in the WBC count prior to PCT administration showed a corresponding decrease of 0.19 × 109/L in the final WBC count. In conclusion, among critically ill patients with sepsis, PCT causes only mild and clinically non-prominent changes in WBC count.

Treatment-experienced patient with Roux-en-Y gastric bypass successfully treated with sofosbuvir/velpatasvir/voxilaprevir: A case report.

PURPOSE: The purpose of this article is to describe a patient with chronic hepatitis C virus (HCV) infection, who had previously taken 2 other direct-acting antiviral (DAA) regimens and undergone Roux-en-Y gastric bypass (RYGB), successfully treated with a sofosbuvir/velpatasvir/voxilaprevir regimen. SUMMARY: A 64-year-old, African American male presented for management of HCV genotype 1a infection after 2 failed courses of treatment. The patient had a history of severe gastroesophageal reflux disease (GERD), and he was unable to discontinue proton pump inhibitor (PPI) use during all treatment regimens. He was originally treated with 12 weeks of ledipasvir/sofosbuvir but relapsed 3 to 4 months post treatment. The patient had undergone RYGB for the treatment of obesity. After surgery, the patient was re-treated with sofosbuvir/velpatasvir plus ribavirin for 24 weeks. The patient again relapsed 3 months after completing therapy. At our clinic, the patient was started on sofosbuvir/velpatasvir/voxilaprevir for 12 weeks. The patient decided on his own to chew the medication, as he was concerned about medication absorption post surgery, and took concurrent once-daily esomeprazole. Confirmatory posttreatment laboratory work showed his HCV RNA viral load remained undetectable, indicating sustained virologic response, and the patient was deemed cured of HCV. CONCLUSION: A patient with a history of relapse after previous DAA therapy and RYGB was successfully treated for HCV infection with sofosbuvir/velpatasvir/voxilaprevir tablets, which he chewed. This case report shows sofosbuvir/velpatasvir/voxilaprevir may be an effective treatment option in the RYGB population, although additional research is needed.