Incidence and Analysis of Adverse Transfusion Reactions at a Single Children’s Hospital / 대한수혈학회지

Adverse transfusion reactions (ATRs) are unexpected reactions to transfusion. This study examined the frequency, types of ATRs, and related blood products retrospectively in pediatric patients with less information than in adult patients. Four hundred and forty transfusions were performed for two months at a children’s hospital: 247 units of red blood cell (RBC) products, 142 units of platelet products, and 41 units of fresh frozen plasma (FFP) were used.Five adverse reactions occurred in five patients, three cases were allergic reactions, and two were febrile nonhemolytic reactions. The frequency was 1.13%, and apheresis platelets and leukocyte-reduced RBC were transfused. Two patients’ ATRs were found in the previous transfusions, and ATRs were repeated in subsequent transfusions in one patient. One of the ATRs was not reported to the blood bank and was then discovered during the study. Because pediatric patients may have limitations in recognizing or expressing their symptoms compared to adults, medical staff rely solely on vital signs and laboratory results rather than symptoms, causing difficulty in noticing ATRs. Information on ATRs and education on appropriate blood products will improve awareness of ATRs and blood management among medical staff at transfusion sites and blood banks.

Analysis of Application of Massive Transfusion Protocol for Trauma Patients at a Single Tertiary Referral Hospital / 대한수혈학회지

BACKGROUND: Massive hemorrhage due to trauma is one of the major causes of death in trauma patients, and the quick supply of appropriate blood products is critical in order to reduce the mortality rate. We introduced a massive transfusion protocol (MTP) for safe and rapid transfusion of trauma patients. Using records collected since its adoption, we compared the characteristics of MTP applied group (MTP group) and MTP not applied group (non-MTP group) to determine whether there is an indicator for predicting patients to be treated with MTP. METHODS: We retrospectively reviewed the electronic medical records and laboratory findings of patients who received massive transfusions in the trauma emergency room of a single tertiary hospital from February to August 2018. We analyzed various laboratory test results, the amount and ratio of the transfused blood products, and the time required for blood products to be released for the MTP group and the non-MTP group. RESULTS: Of the 54 trauma patients who received massive transfusions, 31 were in the MTP group and 22 in the non-MTP group. There was no significant difference in initial vital signs (except blood pressure) and laboratory test results. Also there was no difference in the amount and ratio of blood products, but the time required for blood product release was shorter in the MTP group. CONCLUSION: There was no significant difference in clinical findings such as initial vital signs and laboratory test results between the MTP and non-MTP groups, but required blood products were prepared and released more quickly for the MTP group.

Comparative Analytical Study on Massive Transfusion between Traumatic Emergency and Existing Emergency Rooms for Traumatic Patients at a Tertiary Hospital / 대한수혈학회지

BACKGROUND: Massive transfusion is defined as an 8- to 10-unit transfusion of red blood cells (RBC) within 24 hours in an adult or a 4- to 5-unit transfusion of RBC within 1 hour. Massive transfusion plays an important role in saving the lives of trauma patients. We investigated changes in blood volume and blood product ratios used in massive transfusion in trauma patients at emergency room (ER) and traumatic center emergency room (TER) and evaluated prognostic factors of patients based on mortality. METHODS: We compared massive transfusion requirements for trauma patients between the ER and TER such as amount of transfusion, mortality, and ratio of products. The patients selected were over 18 years old. The patients who were transfused with more than 10 units of RBC within 24 hours were defined as massive transfusion patients. RESULTS: There were a total of 189 people who received massive transfusions at the ER over 4 years, and 67 patients were transfused at the TER over 1 year. There was no significant difference in the ratio of blood products between the two groups, but the mortality rate of the ER (63.1%) was significantly higher than the TER (41.8%). CONCLUSION: The ratio of blood products was not related to patient mortality, but the mortality rate of the TER was lower than that of the ER.

Hidden “Preleukemic Phase” of Chronic Myeloid Leukemia Presenting Without Leukocytosis in the Peripheral Blood Unrelated to Chemotherapy in a Patient Diagnosed With Diffuse Large B Cell Lymphoma

No abstract available.

Delayed Hemolytic Transfusion Reaction with Alloimmunization of Rh Phenotype: A Two-Case Study / 대한수혈학회지

Delayed hemolytic transfusion reaction is difficult to prevent using an unexpected antibody test performed prior to transfusion, and unlike acute hemolytic transfusion reaction, it occurs a few days after blood transfusion. Hence, determining the reason for delayed hemolytic transfusion reaction may be a tim-consuming task for clinicians Here, we report our experience of two cases of delayed hemolytic transfusion reaction as a result of the unexpected antibody production to Rh blood group antigens after transfusion. The first patient with a history of transfusion during admission was identified as having anti-E and anti-C antibodies according to the antibody identification test at the time of re-admission. The second patient who had chronic blood transfusion due to cancer treatment was found to have anti-C antibody. Both patients received transfusion of Rh antigen-compatible RBC units only after unexpected antibody development. However, like both cases, patients receiving continuous blood transfusion should be considered for a routine Rh phenotype test.

Analysis of Massive Transfusion for Trauma Patients and Non-Trauma Patients in a Tertiary Hospital / 대한수혈학회지

BACKGROUND: Management of patients with massive hemorrhage often requires the massive blood transfusions. However, few studies have investigated the effects of massive transfusions on non-traumatic patients. Therefore, this study analyzed mortality and descriptive data for patients receiving massive transfusion, including non-trauma patients and trauma patients. METHODS: We reviewed a retrospective audit of massive transfusions to investigate the major causes, patient characteristics, ratio of the blood components, and the mortality of massively transfused patients. The analysis was performed using electronic medical records collected from January 2010 to December 2013. Patients who had received a massive transfusion (≥10 units of RBCs within 24-hours) were categorized into trauma and non-trauma patients. We calculated the ratio of blood components and investigated the relationship between ratio and mortality. Descriptive statistics were used to characterize the patients and the indications. RESULTS: A total of 532 massive transfusions were performed, including 187 trauma and 345 non-trauma patients. The overall mortality rate was 32.0%, encompassing 36.4% of the trauma patients and 29.6% of the non-trauma patients. The mortality in trauma patients was significantly reduced (P<0.001) within the first 48-hours compared with that in non-trauma patients, which was due to the high FFP: RBC ratio transfusion. The annual FFP: RBC ratio in trauma patients showed an increasing trend. Non-trauma patients showed no relationship between mortality and procedure indication/blood component ratio. CONCLUSION: We report clinical data pertaining to massive transfusions. Annual increasing FFP: RBC ratio in trauma patients was associated with a decreasing mortality. Non-trauma patients showed heterogeneous characteristics and a lower FFP: RBC ratio than trauma patients.

Effect of the Sitting Position after Spinal Anesthesia on the Incidence of Postdural Puncture Headaches: Saddle Block versus Low Spinal Anesthesia

PURPOSE: Postdural puncture headache is one well-known complications of spinal anesthesia. The development of postdurals puncture headaches is related to needle size, the direction of the needle bevel, the number of dural punctures and the age of the patient. However, the effect of the sitting position after spinal anesthesia (saddle block) on the incidence of postdural puncture headaches is not yet known. This study was performed to compare the incidence rates of headaches between a saddle block group (sitting position group) and a low spinal anesthesia group (supine position group). In addition, this study was performed to identify the predisposing factors influencing postdural puncture headaches (age, sex, seasonal variation, onset of headache, location of headache). METHODS: The authors analyzed 960 anal-surgery patients who were operated on using a saddle block or low spinal anesthesia at Hang Cinic from Jan. 2000 through Dec. 2000. The authors compared the incidence rates of headaches between the saddle block group (480 cases) and the low spinal anesthesia group (480 cases). RESULTS: 1) The incidence of postdural puncture headaches was not significantly different between the two groups (2.5% in the saddle block group, and 2.3% in the low spinal anesthesia group) (P>0.05). 2) The postdural puncture headache incidence rate was higher for younger patients (20~30 years) and for females. (M:F=7:16) (P<0.05). 3) The onest of postdural puncture headaches was at the postoperative 2nd day in 16 cases (70%) and at the postoperative 3rd day in 6 cases (26%). 4) The incidence rate of postdural puncture headache was higher in the summer (5 cases in June, and 3 cases in July, 4 cases in August). 5) The headache were located in the frontal region in 16 cases (70%) and in the occipital region in 3 cases (13%). CONCLUSIONS: There is no significant difference in the incidence rates of postdural puncture headaches between the saddle block group and the low spinal anesthesia group. Postdural puncture headaches had a tendency to occur more frequently in young female patients and during the summer season. In addition, a more intensive study of the use of saddle block anesthesia for ambulatory anal surgery is required.

Blood Gas Changes in the Paturient and Fetus under General Anesthesia for Cesarean Section / 대한마취과학회지

Anesthesia for Cesarean Section entails many considerations not pertinent to surgical patients. The anesthesiologist is required to provide anesthesia for mother and fetus simultaneously and to perform emergency anesthesia in high risk paturients with no preoperative evaluation. Variable phrsiologic changes in pregnancy in the cardiovascular, respiratory, gastro-intestinal and renal systems entrance the uptake of anesthetic gases and in the apneic status, PaO2 decreases significantly. During general anesthesia, maternal hypoxia, hyperventilation, aortocaval compression of the enlarged uterus and prolonged induction-delivery time may contribute to circulatory changes which may result in fetal hypoxia and acidosis Kalapa et at (1971) and Gibbs (1981) reported that balanced anesthesia is safe for Cesarean section as long as the time from induction to delivery (IDT) is not prolonged. Maternal arterial blood gases after induction and delivery and fetal umbilical arterial and venous blood gases were measured in 30 paturients under going Cesarean section with thiopental-SCC-N2O-O2 anesthesia (general balanced anesthesia). The relationship between IDT and the apgar score was also studied. The results were as follows : 1) Analysis of tole Paturients arterial blood gases after induction arid after delivery, had no statistical significance. 2) Blood gas analysis from the umbilical of the fetus was pH 7.36 +/- 7.04, PCO2 39.8 +/-3.7 torr, PO2 36.8+/-3.4 torr, BE -2.8+/-0.7 mEq/l and oxygen saturation was 72.2+/-5.8%. Umbilical arterial blood from the fetus was 7.31+/-0.03, PCO2 49.1+/-4.8 torr, PO2 25.9+/-4.7 torr, BE -2.6+/-0.6 mEq/I and oxygen saturation was 36.2+/-3.4%. 3) The results of blood gas tension and acid-base status of the paturient according to IDT were not Statistically Significant in any group- 4) The results of' the apgar score according to IDT indicated that the 1 minute apgar score was statistically singinificant but not clinically the 5 minute appear score was not statistically significant.