Haemoglobin levels and outcomes of subgroups of patients with pre-operative anaemia based on red cell size: A retrospective cohort study.

BACKGROUND: Pre-operative anaemia is common and associated with adverse outcomes. We hypothesised that pre-operative anaemia would be evident more than 1 month pre-operatively, and that peri-operative changes in haemoglobin and post-operative outcomes differed between red cell size-based subsets of anaemia. METHODS: A retrospective single-centre cohort study, including all patients 18 years and older undergoing their first surgery at Landspitali between January 2006 and December 2018 with available measurement of haemoglobin (Hb) within 30 days preceding surgery. Clinical data were compared between patients with subgroups of anaemia classified by mean corpuscular volume (MCV) into microcytic (MCV < 80 fl), normocytic (MCV 80-100 fl), and macrocytic (MCV > 100 fl) anaemia. The development of haemoglobin measurements from a nationwide database was plotted from 1 year pre-operatively to 2 years post-operatively. RESULTS: Of 40,979 patients, 10,505 (25.6%) had pre-operative anaemia, of which 1089 (10.4%) had microcytic anaemia, 9243 (88.0%) had normocytic anaemia, and 173 (1.6%) had macrocytic anaemia. Patients within all subgroups of pre-operative anaemia had a higher degree of comorbidity and frailty burden and a low haemoglobin evident for more than 100 days pre-operatively and similar changes post-operatively. Post-operative prolonged recovery of haemoglobin was slower for macrocytic anaemia than other types of anaemia. All groups of patients with anaemia had a higher incidence of 30-day mortality, acute kidney injury, and rate of readmission compared with patients without anaemia. CONCLUSIONS: Pre-operative anaemia is evident long prior to the procedure and its association with worse outcomes is similar regardless of red cell size.

Coagulation tests on admission correlate with mortality and morbidity in general ICU patients: An observational study.

BACKGROUND: It is well known that low platelet count on admission to intensive care units (ICU) is associated with increased mortality. However, it is unknown whether prothrombin time (PT-INR) and activated partial thromboplastin time (APTT) on admission correlate with mortality and organ failure. Therefore, the aim of this study was to investigate whether PT-INR and APTT at admission can predict outcome in the critically ill patient after adjusting for severity of illness measured with Simplified Acute Physiology Score 3 (SAPS 3). MATERIALS AND METHODS: Data were retrospectively collected. APTT and PT-INR taken on admission and SAPS 3 score were independent variables in all regression analyses. Survival analysis was done with Cox regression. Organ failure was reported as days alive and free (DAF) of vasopressors and invasive ventilation, need of continuous renal replacement therapy (CRRT) and Acute Kidney Injury Network creatinine score (AKIN-crea). RESULTS: A total of 3585 ICU patients were included. Prolonged APTT correlated with mortality with 95% confidence interval (CI) of hazard ratio 1.001-1.010. Prolonged APTT also correlated with DAF vasopressor, CRRT and AKIN-crea with 95% CI of odds ratio (OR) 1.009-1.034, 1.016-1.037 and 1.009-1.028, respectively. Increased PT-INR correlated with DAF vasopressor and DAF ventilator with 95% CI of OR 1.112-2.014 and 1.135-1.847, respectively. CONCLUSIONS: Activated partial thromboplastin time prolongation was associated with mortality and all morbidity outcomes except the DAF ventilator. PT-INR increase at admission was associated with DAF vasopressor and DAF ventilator. APTT and PT-INR at admission correlate with morbidity, which is not accounted for in the SAPS 3 model.

Linear decline of corrected platelet count increment within 24 hours after platelet transfusion in haematological patients: A prospective observational study.

OBJECTIVES: The aim of this study was to prospectively explore the detailed longitudinal development of platelet increments in patients with chemotherapy-induced bone marrow aplasia during the first 24 hours after platelet transfusion. METHODS: Patients admitted to the Haematology department during 7 months, and fulfilled inclusion criteria were divided into 4 groups: Group 1, patients with acute leukaemia; Group 2, patients after autologous stem cell transplantation (SCT); Group 3, patients after allogeneic SCT; and Group 4, patients given platelet transfusion prior to intervention. We used frequent blood sampling within 24 hours after platelet transfusion to investigate the kinetics of platelet counts following transfusion. RESULTS AND CONCLUSIONS: Fifty-four platelet transfusion occasions in patients with chemotherapy-induced bone marrow aplasia were included. The decrease in corrected count increment (CCI) 1-24 hours after platelet transfusions in all groups could be described as linear functions. For patients in the aggregated Groups 1-3, the decline was 2.0% ± 0.6% (mean ± standard deviation) per hour. For patients in Group 4, the decline of CCI was 2.8% ± 1.2% per hour. We found no differences between the groups, either in the rate of platelet elimination from the bloodstream or in the mean CCI, in the first 24 hours post-transfusion.

[Management of patients with STEMI transported with air-ambulance to Landspitali University Hospital in Reykjavík]. / Flutningstími og gaedi medferdar hjá sjúklingum med ST-haekkunar hjartadrep á Nordur- og Austurlandi.

INTRODUCTION: A good outcome of patients presenting with STEMI (ST-Segment Elevation Myocardial Infarction) depends on early restoration of coronary blood flow. Pre-hospital fibrinolysis is recommended if primary percutaneous coronary intervention (PPCI) cannot be performed within 90 minutes of first medical contact (FMC). The purpose of this study was to study transport times for patients with STEMI who were transported with air-ambulance from the northern rural areas of Iceland to Landspitali University Hospital in Reykjavík, and to assess if the medical management was in accordance with clinical guidelines. MATERIALS AND METHODS: Retrospective chart review identified 33 patients with STEMI who were transported with air-ambulance to Landspitali University Hospital in Reykjavík during the years 2007 and 2008. RESULTS: The total time from first medical contact to arrival at Landspitali University Hospital emergency room was 3 hours and 7 minutes (median). All patients received aspirin and 26 (78.8%) received clopidogrel and enoxaparin. 16 patients (48.5%) received thrombolytic therapy in median 33 minutes after FMC and 15 patients had PPCI performed in median 4 hours and 15 minutes after FMC. Estimated PCI related delay was 3 hours and 42 minutes (median). One patient died and one was resuscitated within 30 hospital days. Mean hospital stay was 6.0 days. CONCLUSIONS: First medical contact to balloon time of less than 90 minutes is impossible for patients with STEMI transported from the northern rural areas to Landspitali University Hospital in Reykjavík. Medical therapy was in many cases suboptimal and PCI related delay too long.