Patient blood management: Myths and facts about red blood cell transfusions.

Transfusion medicine resembles all of medicine in that expert opinion predominates because hard data on clinical outcomes from randomized controlled trials and high quality observational data are simply unavailable. Indeed, some of the first trials evaluating important outcomes are barely two decades old. Patient blood management (PBM) depends on high quality data for assisting clinicians in making clinical decisions. In this review, we focus on several red blood cell (RBC) transfusion practices that new data suggest need reconsideration. The practices that may need revision include transfusion for iron deficiency anaemia, except in life threatening situations, toleration of anaemia as a largely benign condition and use of haemoglobin/haematocrit as primary indications for RBC transfusion, as opposed to adjuncts to clinical judgement. In addition, the long-standing notion that the minimum transfusion should be two units needs to be abandoned due to the danger to patients and a lack of clinical evidence of benefit. Finally, the difference in indications for leucoreduction versus irradiation needs to be understood by all practitioners. PBM is one of the strategies for managing anaemia and bleeding that holds great promise for patients, and transfusion is only one facet of the bundle of practices.

Autologous blood transfusion in a neurosurgical patient with multiple alloantibodies.

There are many challenges to obtain antigen-negative, crossmatch compatible blood for a patient with multiple alloantibodies. We present a case report of a 31-year-old female patient with a recurrent pontine cavernoma who was to undergo a neurosurgical procedure. We identified alloantibodies anti-Fya and anti-c in her blood sample. To meet her intraoperative blood requirement, we attempted with autologous blood transfusion using both predeposit autologous donation and acute normovolemic hemodilution. Autologous blood alone was sufficient despite anticipating surgical blood loss and a postoperative surgical site infection.

Iron Overload in Children with Leukemia Receiving Multiple Blood Transfusions.

OBJECTIVE: To find out prevalence of iron overload in children with leukemia at the end of treatment, and to identify factors affecting iron overload. METHODS: Children (age-1-14 y) treated for Leukemia of our center who completed treatment between January and August 2016 were included in the study. Serum ferritin and iron were measured at completion of treatment and total blood transfusion received throughout treatment was quantified. Serum ferritin >1000 ng/mL was considered as marker of transfusional iron overload. RESULTS: Out of 66 participants, 55 (83.3%) received red cell transfusions. Average transfused volume was 48 mL/kg, and patients with high-risk leukemia received more transfusions than standard-risk patients. 16 patients (24.2%) demonstrated transfusional iron overload. Total transfused volume and treatment intensity were significant factors associated with iron overload, and total transfused volume of >100 mL/kg (approximately 10 transfusions) was the most important determinant of transfusional iron burden. CONCLUSIONS: One-fourth of pediatric leukemia patients demonstrated iron overload at the end of treatment. These patients need to be monitored and followed-up after treatment to assess need for later chelation therapy.

Rosette forming glioneuronal tumor of the fourth ventricle in squash cytology smear.

Rosette forming glioneuronal tumor (RGNT) is a recently recognized and extremely rare glioneuronal tumor occurring in the fourth ventricle. It is crucial for the cytopathologist to be aware of this entity as it can be easily mistaken for more common neoplasms occurring at this site. We present here the cytology of such a rare case of RGNT that was misdiagnosed as ependymoma. The varying cytological features of this entity, as well as the common diagnostic difficulties encountered in cytology, are highlighted in this report.

Moderately differentiated peripheral adenocarcinoma of the lung with cilia.

We report an extremely rare case in which cilia were identifiable on light microscopic examination in cells of a moderately differentiated peripheral adenocarcinoma in the lung. The cells were positive for cytokeratin 7, and the cilia were highlighted by epithelial membrane antigen staining. The prognostic significance of these extremely well-differentiated ciliated tumor cells will be known only with long-term follow-up of the patient and analysis of more such tumors.