RESUMO
BACKGROUND: The paediatric massive transfusion protocol (MTP) is activated in the paediatric population for both trauma and non-trauma related indications. While it helps to improve the efficiency and efficacy of the delivery of blood products, it can also result in increased wastage. We aimed to evaluate the wastage rates from our paediatric MTP activations from 2013 to 2018. METHOD: As part of an audit, we retrospectively reviewed the records of the paediatric patients who had MTP activations. We collected the following data: reason for MTP activation, weight of patient, number of cycles of MTP required, blood products used, blood products wasted, deviation from our institution's recommended MTP blood product ratio, and reason for wastage. RESULT: We had 26 paediatric MTP activations within the audit period. There was an overall wastage rate of 1.5%, with wastage occurring in 3 out of 26 patients. The reason for all wastage was demise of the patient. Most patients' transfusion ratios deviated from our institution's MTP protocol. CONCLUSION: Our wastage rates are low likely because of clear MTP activation guidelines and a flexible MTP workflow.
RESUMO
Troponin I is a cardiac enzyme that is released during myocardial injury. However, cardiac enzymes are non-specific and can occur in many cardiac and non-cardiac pathologies. We aim to (1) describe the range of acute conditions that were associated with raised troponins in the paediatric population in our institution and (2) quantify the extent of troponin elevation and correlate it with the underlying aetiology. We performed a retrospective observational study in a tertiary institution which included patients from 1 January 2009 to 31 December 2013. We identified patients with troponin I levels of more than 0.1 ng/ml who have not had cardiac surgery before. We recorded their final diagnoses, and then compared the peak troponin levels and the eventual final diagnoses. We identified 100 patients. The top few common diagnoses resulting in a raised troponin were sepsis (29%), cardiac pathologies (29%) such as tachyarrhythmias and cardiomyopathies and myocarditis (21%). Other pathologies included trauma and other causes of multiorgan dysfunction. The median peak troponin I was higher in cardiac as compared to non-cardiac pathologies: 2.15 (0.52-15.0) and 0.44 (0.21-1.68), respectively. There was no statistically significant difference in the peak troponin I values in the presence of hypotension or renal impairment. We described the range of conditions that may result in raised troponin I levels. The extent of raised troponin I levels may potentially be useful in differentiating between cardiac and non-cardiac pathologies. However, further studies on a larger scale are required to establish whether extent of troponin I elevation has a diagnostic role for cardiac pathologies.
