Transfusion treatment at Sestre Milosrdnice University Hospital Center during a twelve-year period.

Transfusion treatment is administered according to clinical and laboratory results, with ongoing patient assessments. Decisions on necessary measures to prevent any adverse and unexpected events and reactions are made on the basis ofhemovigilance and ongoing gathering and analysis of relevant data. Information about transfusion treatment at the Sestre milosrdnice University Hospital Center, Vinogradska site, was retrospectively collected for a period of twelve years (2001-2012). In that period, 14137.25 ± 1693.07 units of all blood products were used, where red blood cells (RBC) accounted for 67.34%, fresh frozen plasma (FFP) for 17.55%, and platelet concentrates (PC) for 14.32%. During the study period, the consumption of RBC was even, of FFP decreased by 45% and of PC increased by 58%. RBC transfusions were received by 10.43% of hospitalized patients, 1.46% of them during surgical procedures. Transfusions of all blood products were received by 14.63% of patients. We found 247 adverse reactions to all blood products. Febrile nonhemolytic and allergic reactions were quite equally represented, 49.5% each. As for other reactions (1%), one transfusion associated circulatory overload and one transfusion related acute lung injury were recorded. There were no fatal post-transfusion reactions.

[The importance of antenatal immunoprophylaxis for prevention of hemolytic disease of the fetus and newborn]. / Vaznost antenatalne imunoprofilakse u prevenciji hemoliticke bolesti fetusa i novorodenieta.

Hemolytic disease of the fetus and newborn (HDFN) is a consequence of maternal alloimmunization against fetal red blood cell antigens. Alloimmunization against D antigen from Rhesus (Rh) blood group system is particularly important because of its strong immunogenicity. During the last few decades, the introduction of RhD prophylaxis by postpartum administration of anti-D immunoglobulin to RhD negative women, now improved with antenatal prophylaxis, has led to a dramatic decrease in perinatal mortality and morbidity from HDFN. However, severe cases have not disappeared, mostly due to prophylaxis failure. In our case, inappropriate prenatal care during the first pregnancy in an RhD negative mother resulted in primary immunization. In the next pregnancy with an RhD positive child, the mother's secondary immune response was extremely strong and led to early development of severe fetal anemia. The fetus survived thanks to the treatment with intrauterine transfusions (IUT), but they caused suppression of erythropoiesis, which lasted for months after birth. The long lasting, late anemia was treated with repeated postnatal red cell transfusions and recombinant human erythropoietin (rHuEPO). Despite the severity of HDFN in our case, the short-term outcome is good. The boy has normal growth until now, but due to the possibility of an adverse long-term neurodevelopmental outcome, this case requires continuous follow up. It also reminds of the fact that RhD alloimmunization remains an actual problem in daily routine. Antenatal prophylaxis is a crucial step in quality care of those who are at a risk of HDFN.

Combined megaloblastic and immunohemolytic anemia associated--a case report.

A 55-year-old female with a history of psychosis and rheumatoid arthritis was admitted to the hospital for fatigue and dizziness. At admission, macrocytic anemia, high serum lactic acid dehydrogenase (LDH) and gastrin concentrations, decreased serum vitamin B12 concentration, with macroovalocytes and poikilocytes in peripheral blood smear suggested the diagnosis of pernicious anemia. Indirect antiglobulin test (IAT) was negative. Surprisingly, treatment by vitamin B12 and folic acid administered for two weeks was ineffective and followed by transitory worsening of hemoglobin concentration on day 8. Repeat direct antiglobulin test (DAT) and IAT were positive. This immunotransfusion conversion, suggesting the presence of autoimmune hemolytic anemia, could be explained by change in the macroblastic erythrocyte population, i.e. emerging red cells with completely exposed membrane antigens due to vitamin B12 treatment and/or higher degree of dysregulation of the lymphocyte clone secreting erythrocyte autoantibodies. We proposed the coexistence of pernicious and autoimmune hemolytic anemia; therefore, methylprednisolone was added to vitamin B12 treatment. This therapy successfully improved hemoglobin and erythrocyte concentration. Although megaloblastic-pernicious anemia is a common disease, association of pernicious and autoimmune hemolytic anemia with two mechanisms of hemolysis (ineffective erythropoiesis and immune mechanism) is a rare condition, with only several dozens of cases described so far.

[Is transfusion of a single dose of concentrated erythrocytes poor clinical practice?]. / Je li transfuzija jedne doze koncentriranih eritrocita losa klinicka praksa.

The aim of the study was to determine whether a single unit of red blood cell (RBC) transfusion is a true criterion of poor patient care. Medical records of 148 patients, 76 (51.4%) males, 72 (48.6%) females, mean age 66.88 +/- 14.56 years who have received a single unit RBC transfusion at the Department of Medicine in the period from 1997 to 2000 were retrospectively studied. Pretransfusion mean hemoglobin (Hb) value (Hb1) was 85.0 +/- 12.0 (mod 78) g/L, increasing to (Hb2) 96.9 +/- 11.8 (mod 90) g/L after transfusion and the last measured value (Hb3) was 98.2 +/- 13.4 (mod 102) g/L. Six patients (66.6%) of 9 with decrease in Hb3 value (group A) died, 13 patients (35.1%) of 37 with raise in Hb3 level < 5 g/L (group B) and 5-10 g/L (group C) died during the hospital stay vs. 7 patients (6.8%) of 102 with Hb3 level raise > 10 g/L (group D). The differences between the Hb2 and Hb1 values were significant considerably from the differences between the Hb3 and Hb1 values (p = 0.001), as well as the difference in the distribution of differences between Hb2 and Hb1 (p 0.028) and Hb3 and Hb1 (p = 0.001) according to the disease outcome and the difference in mortality of men and women (p = 0.021). 38.4% of the deceased patients were from the group of coronary syndrome and/or heart failure. Statistically significant were the differences between the arterial oxygen tension (PaO2) at Hb1 and Hb2 (p = 0.0001), as well as between the arterial oxygen saturation (SaO2) at the Hb1 and Hb2 values (p = 0.0001). There is no strict clinical indication for a single unit of RBC transfusion. Determinants of the need and amount of RBC transfusion except hemoglobin value include the etiology and duration of the anemia, the patient's ability to compensate for decreased oxygen carrying capacity and tissue oxygen requirements. The majority of a single unit RBC transfusion was appropriate for the clinical situation. Our data indicate that the use of smaller volumes of allogenic RBC transfusion was not a bad clinical practice.