Routine pretransfusion testing before primary total hip or knee arthroplasty are an expensive and wasteful routine. Systematic review and meta-analysis.

BACKGROUND: The excessive routine ordering of pretransfusion tests (blood typing, screening, and cross-matching) for surgical cases incurs significant unnecessary costs and places an undue burden on transfusion services. This study aims to systematically review the literature regarding the necessity of routine pretransfusion tests before total hip arthroplasty (THA) or total knee arthroplasty (TKA) and summarize their outcomes. STUDY METHODS: A systematic review and meta-analysis were performed. The study's characteristics, the prevalence of over-ordering pretransfusion tests, transfusion rates, and potential cost savings to the healthcare system were analyzed. RESULTS: The study included 17,667 patients. Pooled results revealed a 96.3% over-ordering pretransfusion test rate (95% CI: 0.92-1.00; p < 0.001) among patients undergoing primary THA or TKA. The pooled prevalence of hospital transfusion rate was 3.6%. Notably, there were statistically significant differences in preoperative hemoglobin (Hb) levels between patients not requiring transfusion (Hb = 13.9 g/dl; 95% CI 12.59-15.20; p < 0.001) and those needing transfusion (Hb = 11.9 g/dl; 95% CI 10.69-13.01; p < 0.001) (p = 0.03). The per-patient total cost savings ranged from 28.63 to 191.27 dollars. DISCUSSION: Our study suggests that routine pre-transfusion testing for all patients undergoing primary THA or TKA may be unnecessary. We propose limiting pretransfusion test orders to patients with preoperative hemoglobin levels below 12 g/dl in unilateral primary TKA or THA. This targeted approach can result in significant cost savings for healthcare systems and transfusion services by reducing the over-ordering of pretransfusion tests in these surgical procedures.

Compromiso hepático por Dengue en niños del Huila, Colombia / Dengue-related hepatic compromise in children from the Huila department of Colombia

Objetivo Determinar la frecuencia y severidad del compromiso hepático en niños con Dengue. Métodos Estudio descriptivo que incluyó a 108 niños menores de 13 años con diagnóstico de infección por virus de Dengue, confirmada por detección plasmática de NS1 e IgM dengue-específica, que consultaron al Hospital Universitario de Neiva, en el período de junio de 2009 a mayo de 2010.El grado de daño hepático fue evaluado por criterios clínicos y bioquímicos que incluyeron transaminasas y albúmina. El diagnóstico de infección con Leptospira o Hepatitis A fue realizado por detección de IgM plasmática específica medida en fase aguda y convaleciente. Resultados De los casos incluidos, 98 y 10 casos fueron clasificados como dengue con signos de alarma y Dengue grave, respectivamente. Dos de cada tres pacientes con Dengue presentaron signos de alarma y todos los pacientes con Dengue grave presentaron algún grado de compromiso hapático evidenciado clínica y bioquímicamente. Independientemente de la clasificación clínica, la hepatomegalia fue el signo clínico cardinal del compromiso hepático y se presentó en el 85 % del total de niños incluidos. De resaltar, 5 de los pacientes presentaron probable coinfección de dengue y leptospira, siendo la primera descripción en Colombia. En ninguno de los casos analizados se presentó enfermedad aguda por Hepatitis A. Conclusión El compromiso hepático es muy frecuente en la infección por virus Dengue. Enfermedades como la leptospirosis deben ser tenidas en cuenta no sólo en el diagnóstico diferencial del paciente pediátrico febril con compromiso hepático, sino como causa de coinfección en el niño con Dengue en el sur de Colombia.

Objective Dengue is the most important arthropod-borne viral disease in the world; it can be life-threatening because of liver involvement. Aim Determining liver involvement frequency and severity in dengue-infected children. Methods This was a descriptive case series study which involved studying 108 dengue-infected children aged less than 13 years old whose infection had been confirmed by the detection of dengue-specific IgM and NS1 in plasma. Clinical and biochemical parameters were used for evaluating liver involvement, including transaminases and albumin. Hepatitis A and leptospira infection were also evaluated by using ELISA to detect pathogen-specific IgM in plasma during acute and convalescence phases. The study was carried out at a teaching hospital in Neiva from June 2009 to May 2010. Results Ninety-eight of the aforementioned cases were clinically classified as dengue with warning signs (DWS) and 10 as severe dengue (SD). Two out of three DWS patients and all SD patients had some degree of liver involvement, shown clinically and biochemically. Regardless of the clinical classification, hepatomegaly was the main clinical sign of liver involvement and was present in 85% of all the children in the study. It is worth noting that 5 patients had probable dengue and leptospirosis co-infection, this being the first instance of this in Colombia. None of the cases analyzed here had acute hepatitis A. Conclusions Liver compromise should be considered in confirmed cases of dengue as shown in this series of children. Leptospirosis must be considered as differential diagnosis and also as causing co-infection in a febrile child.

[Dengue-related hepatic compromise in children from the Huila department of Colombia]. / Compromiso hepático por Dengue en niños del Huila, Colombia.

OBJECTIVE: Dengue is the most important arthropod-borne viral disease in the world; it can be life-threatening because of liver involvement. Aim Determining liver involvement frequency and severity in dengue-infected children. METHODS: This was a descriptive case series study which involved studying 108 dengue-infected children aged less than 13 years old whose infection had been confirmed by the detection of dengue-specific IgM and NS1 in plasma. Clinical and biochemical parameters were used for evaluating liver involvement, including transaminases and albumin. Hepatitis A and leptospira infection were also evaluated by using ELISA to detect pathogen-specific IgM in plasma during acute and convalescence phases. The study was carried out at a teaching hospital in Neiva from June 2009 to May 2010. RESULTS: Ninety-eight of the aforementioned cases were clinically classified as dengue with warning signs (DWS) and 10 as severe dengue (SD). Two out of three DWS patients and all SD patients had some degree of liver involvement, shown clinically and biochemically. Regardless of the clinical classification, hepatomegaly was the main clinical sign of liver involvement and was present in 85% of all the children in the study. It is worth noting that 5 patients had probable dengue and leptospirosis co-infection, this being the first instance of this in Colombia. None of the cases analyzed here had acute hepatitis A. CONCLUSIONS: Liver compromise should be considered in confirmed cases of dengue as shown in this series of children. Leptospirosis must be considered as differential diagnosis and also as causing co-infection in a febrile child.