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1.
Am J Case Rep ; 23: e934681, 2022 Jan 05.
Artigo em Inglês | MEDLINE | ID: mdl-34983921

RESUMO

BACKGROUND Transfusion therapy has a well-established role in the management of several sickle cell disease (SCD)-related complications. Nevertheless, the benefits of transfusion must outweigh the possible risks, including iron overload, infections, and transfusion reactions. Alloimmunization is the underlying etiology of most delayed hemolytic transfusion reactions (DHTR). DHTR is often underestimated and underdiagnosed in sickle cell disease patients as it mimics a vaso-occlusive crisis in presentation. Alloimmunization to RBC antigens can be a serious complication of transfusion, which is of particular interest in individuals with SCD, as the occurrence rate is higher in this population. This complication represents a secondary immunological phenomenon that typically arises after the emergence of an alloantibody to which the patient had been previously sensitized to. CASE REPORT Here, we report 2 cases of delayed hemolytic transfusion reaction (DHTR) in which the patients showed evidence of alloimmunization from previous blood transfusions. The patients were managed with a variety of medications, including supportive treatments, utilization of immunosuppressive agents, and enhancement of erythropoiesis. Both patients had evidence of clinical and laboratory improvement following the management. CONCLUSIONS DHTR is considered one of the most deleterious complications of transfusion in SCD patients. The diagnosis and management of DHTR is very challenging, especially because it can present differently in this population. A high index of clinical suspicion is needed in addition to the laboratory criteria.


Assuntos
Anemia Hemolítica Autoimune , Anemia Falciforme , Reação Transfusional , Anemia Falciforme/complicações , Anemia Falciforme/terapia , Transfusão de Sangue , Humanos , Isoanticorpos
4.
Am J Hosp Palliat Care ; 39(1): 68-71, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33926274

RESUMO

AIMS: The inability to prescribe blood transfusions is a potential barrier to timely hospice enrollment for patients with blood cancers. The benefits and harms of transfusions near the end of life (EOL), however, are poorly characterized and patients' preferences are unknown. We sought to characterize the recollections of bereaved caregivers about the relationships between transfusions and hospice enrollment decisions. METHODS: We recruited 18 bereaved caregivers of 15 decedents who died within 6-18 months of the interview. Interviews focused on caregivers' recollections of transfusion and hospice enrollment decisions. Transcripts were analyzed for themes. RESULTS: We identified 2 themes. First, caregivers described that transfusions were necessary and the decisions to receive transfusions or not were deferred to the clinicians. Second, only 1 caregiver recalled transfusions as relevant to hospice decisions. In that instance there was a delay. Caregivers identified difficulties recognizing death was imminent, hope for miracles, and the necessity of accepting life was ending as more relevant barriers. CONCLUSIONS: The results indicate clinicians' beliefs in transfusion at EOL may be a more relevant barrier to hospice enrollment than patients' preferences. Strategies to evaluate accurately and discuss the actual benefits and harms of transfusions at the EOL are necessary to advise patients and integrate their preferences into decisions.


Assuntos
Cuidados Paliativos na Terminalidade da Vida , Hospitais para Doentes Terminais , Leucemia Mieloide Aguda , Transfusão de Sangue , Cuidadores , Humanos , Leucemia Mieloide Aguda/terapia
5.
J Intensive Care Med ; 37(1): 100-106, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33307945

RESUMO

BACKGROUND: Despite the importance of transfusion in treating sickle cell disease acute chest syndrome, the target hemoglobin and optimal modality for transfusion remain unknown. OBJECTIVES: To compare hospital length of stay (LOS) in intensive care unit (ICU) patients with acute chest syndrome transfused to hemoglobin ≥ 8 g/dL versus patients transfused to hemoglobin < 8 g/dL; and to compare hospital LOS in acute chest syndrome patients treated with and without exchange transfusion. METHODS: We performed a retrospective cohort study of all acute chest syndrome patients treated in the medical ICU at 2 tertiary care hospitals between January 2011 and August 2016 (n = 82). We compared median hospital LOS in patients transfused to hemoglobin ≥ 8 g/dL by the time of ICU transfer to the medical floor versus patients transfused to hemoglobin < 8 g/dL as well as patients who received exchange transfusion versus no exchange transfusion using Wilcoxon rank-sum tests. We modeled the association between hospital LOS and hemoglobin at ICU transfer to the medical floor using multivariable log-linear regression. RESULTS: Median hospital LOS was about half as long for patients transfused to hemoglobin ≥ 8 g/dL versus hemoglobin < 8 g/dL (8.0 versus 16.5 days, P = 0.008). There was no difference in LOS for patients treated with and without exchange transfusion. On average, a 1 g/dL increase in hemoglobin was associated with a 19.5% decrease (95% CI 10.8-28.2%) in LOS, controlling for possible confounding factors. CONCLUSIONS: Transfusion to a hemoglobin target ≥ 8 g/dL is associated with decreased hospital LOS in patients with acute chest syndrome. There was no difference in LOS between patients who received exchange transfusion and those who did not.


Assuntos
Síndrome Torácica Aguda , Anemia Falciforme , Síndrome Torácica Aguda/etiologia , Síndrome Torácica Aguda/terapia , Adulto , Anemia Falciforme/complicações , Anemia Falciforme/terapia , Transfusão de Sangue , Hemoglobinas/análise , Humanos , Estudos Retrospectivos
6.
Gut ; 71(1): 100-110, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-33619167

RESUMO

BACKGROUND: There were limited data on the risk of post-polypectomy bleeding (PPB) in patients on direct oral anticoagulants (DOAC). We aimed to evaluate the PPB and thromboembolic risks among DOAC and warfarin users in a population-based cohort. METHODS: We performed a territory-wide retrospective cohort study involving patients in Hong Kong from 2012 to 2020. Patients who received an oral anticoagulant and had undergone colonoscopy with polypectomy were identified. Propensity-score models with inverse probability of treatment weighting were developed for the warfarin-DOAC and between-DOAC comparisons. The primary outcome was clinically significant delayed PPB, defined as repeat colonoscopy requiring haemostasis within 30 days. The secondary outcomes were 30-day blood transfusion requirement and new thromboembolic event. RESULTS: Apixaban was associated with lower PPB risk than warfarin (adjusted HR (aHR) 0.39, 95% CI 0.24 to 0.63, p<0.001). Dabigatran (aHR 2.23, 95% CI 1.04 to 4.77, adjusted p (ap)=0.035) and rivaroxaban (aHR 2.72, 95% CI 1.35 to 5.48, ap=0.002) were associated with higher PPB risk than apixaban. In subgroup analysis, apixaban was associated with lower PPB risk in patients aged ≥70 years and patients with right-sided colonic polyps.For thromboembolic events, apixaban was associated with lower risk than warfarin (aHR 0.22, 95% CI 0.11 to 0.45, p<0.001). Dabigatran (aHR 2.60, 95% CI 1.06 to 6.41, ap=0.033) and rivaroxaban (aHR 2.96, 95% CI 1.19 to 7.37, ap =0.013) were associated with higher thromboembolic risk than apixaban. CONCLUSIONS: Apixaban was associated with a significantly lower risk of PPB and thromboembolism than warfarin, dabigatran and rivaroxaban, particularly in older patients with right-sided polyps.


Assuntos
Pólipos do Colo/cirurgia , Colonoscopia , Inibidores do Fator Xa/efeitos adversos , Hemorragia Gastrointestinal/epidemiologia , Tromboembolia/epidemiologia , Varfarina/efeitos adversos , Idoso , Anticoagulantes/efeitos adversos , Transfusão de Sangue/estatística & dados numéricos , Estudos de Coortes , Dabigatrana/efeitos adversos , Hong Kong/epidemiologia , Humanos , Masculino , Complicações Pós-Operatórias/epidemiologia , Pirazóis/efeitos adversos , Piridonas/efeitos adversos , Estudos Retrospectivos , Medição de Risco , Rivaroxabana/efeitos adversos
7.
Emerg Infect Dis ; 28(1): 219-223, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-34932935

RESUMO

We report a transfusion-transmitted hepatitis A virus infection in an immunocompromised patient in France, detected shortly after a transfusion of pathogen-reduced pooled platelets. This case raises questions about the efficacy of donor screening methods. Additional safety measures, such as routine donation screening, should be considered.


Assuntos
Vírus da Hepatite A , Torque teno virus , Doadores de Sangue , Transfusão de Sangue , Vírus da Hepatite A/genética , Humanos , Hospedeiro Imunocomprometido , Programas de Rastreamento
8.
Ulus Travma Acil Cerrahi Derg ; 28(1): 90-93, 2022 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-34967432

RESUMO

BACKGROUND: In this article, we aimed to evaluate results of patients who acquired various injuries during Libya civil war who then were transferred to our facility with genitourinary trauma for further assessment and treatment. METHODS: A total of 121 wounded patients, including 21 (17.3%) with 1 or more combined urogenital injuries, were treated at Yeni Yüzyil University Private Gaziosmanpasa Hospital from October 2014 to September 2016. RESULTS: Of the 21 patients, 13 (61.9%) were injured by explosive weapons, while the rest 8 (38.1%) had bullet wounds. The 21 urogenital injuries were to the kidney in 7 cases (33.4%), ureter in 5 (23.8%), bladder in 5 (23.8%), scrotum in 2 (9.5%), and penis in 2 (9.5%). There was associated damage to organs other than the urogenital system in 21 patients (100%). Two patients had nephrectomies performed on-site medical facility. The rest of patients had no urogenital organ resections. Urogenital trauma had higher rates of liver damage, generalized infection, blood transfusions, and longer hospital stay. CONCLUSION: Knowing that war related surgery patients should be approached as a distinct and non-standard category, every case must be evaluated individually. Patients should be evaluated in a multidisciplinary approach and physicians should be aware of infections affecting morbidity and mortality.


Assuntos
Rim , Sistema Urogenital , Transfusão de Sangue , Humanos , Tempo de Internação , Líbia/epidemiologia , Masculino
9.
BMC Infect Dis ; 21(1): 1278, 2021 Dec 24.
Artigo em Inglês | MEDLINE | ID: mdl-34952570

RESUMO

BACKGROUND: Preliminary studies revealed the safety and effectiveness of convalescent plasma (CP) therapy for patients with coronavirus. In this study, we aimed to evaluate and summarize the available evidence on CP therapy, identify the research gap regarding the immunological response to CP therapy and pave the road for future studies. METHODS: This study was conducted according to the Hilary Arksey and Lisa O'Malley framework. To find out the relevant studies, we searched PubMed, Scopus and Embase databases up to 30th May 2021. Data have been extracted according to three categories: (1) patients' characteristics, (2) clinical and immunological responses to CP therapy and (3) pre-infusion screening of the CP samples. RESULTS: A total of 12,553 articles were identified. One hundred fifty-four studies met the inclusion criteria for full-text review. More than half of the included studies (112 studies, (75.6%)) concluded satisfactory outcomes and or safety of CP infusion in patients. Results of studies showed the efficacy of CP therapy in clinical improvement (101 studies), decreasing in the level of inflammatory factors (62 studies), elimination or decreasing in viral load (60 studies), and induction or increase in antibody response (37 studies). Despite these promising results, the results of the 49 studies revealed that CP therapy was ineffective in the survival of patients, clinical improvement, viral infection elimination or decrease in the inflammatory factor levels. Furthermore, the adaptive immune response was evaluated in 3 studies. Information related to the pre-infusion screening for human leukocyte antigen/human neutrophil antigen (HLA/HNA) antibodies was not reported in most of the studies. Our gap analysis revealed that the influence of the CP infusion on the adaptive immune and inflammatory responses in patients with coronavirus needs further investigation. CONCLUSIONS: Based on the results of most included studies, CP infusion was safe and resulted in clinical improvement of patients and decreasing the viral load. The effect of the CP infusion on adaptive immune response and inflammatory cytokines in patients with coronavirus needs further investigation.


Assuntos
COVID-19 , Transfusão de Sangue , Humanos , Imunização Passiva , Plasma , SARS-CoV-2
10.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(11): 1306-1309, 2021 Nov 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-34911867

RESUMO

A male infant, whose weight was 1 120 g at 28+2 weeks of gestational age, was admitted to Neonatal Intensive Care Unit of West China Second Hospital of Sichuan University at 20 min after preterm birth. Blood transfusion was performed for anemia (hemoglobin 81 g/L) on day 30 of hospitalization, and feeding was continued during the transfusion. Eight hours after blood transfusion, the patient's manifestations included abdominal distension and stiff to palpation, bowel sound weakening, currant jelly stool, poor responsiveness, and apnea. The clinical diagnosis was necrotizing enterocolitis. Abdominal X-ray showed that the abdominal bowel was significantly dilated and inflated. The patient was immediately treated with fasting, gastrointestinal decompression, enema, and anti-infection treatment. After 40 days in hospital, the patient recovered and was discharged.


Assuntos
Anemia , Enterocolite Necrosante , Nascimento Prematuro , Transfusão de Sangue , Enterocolite Necrosante/etiologia , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Masculino
11.
Curr Urol Rep ; 22(12): 65, 2021 Dec 16.
Artigo em Inglês | MEDLINE | ID: mdl-34913084

RESUMO

PURPOSE OF REVIEW: The purpose of current systematic review and meta-analysis is to determine the efficacy and safety of the administration of tranexamic acid in patients undergoing PCNL. The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement. This systematic review and meta-analysis includes randomized comparative prospective studies. RECENT FINDINGS: The primary endpoints were the hemoglobin drop, the bleeding complications, and the transfusion rate. Secondary endpoints included the operative time, the stone-free rate, the hospital stay, and the overall complications. Two-thousand five-hundred six publications were screened for this study. Six RCTs (1262 patients) were included in the meta-analysis. As for our primary endpoints, the hemoglobin drop was lower in the tranexamic group than in the control group, with mean difference (MD) of - 0.65 (p < 0.0001); the bleeding complications were rarer in the tranexamic group than in the control group, with an odds ratio (OR) of 0.32 (p < 0.00001); and the transfusion rate was lower in the tranexamic group with an OR of 0.34 (p = 0.0007). Concerning the secondary endpoints, the operative time was less in the tranexamic group with an MD of - 10.39 (p < 0.0001), the meta-analysis of the stone-free status data showed no statistical significance between the two groups with an OR of 1.58 (p = 0.09), the hospital stay was significantly less in the tranexamic group with an MD of - 1.38 (p = 0.005), and the overall complications were rarer in the tranexamic group than in the control group with an OR of 0.34 (p = 0.12). The peri-operative use of TA contributes to the reduction of blood loss, bleeding complications, mean operative time, and hospital stay. The use of TA seemed to be safe and well tolerated in patients undergoing PCNL. PROSPERO protocol (Registration number: CRD42019122818).


Assuntos
Nefrolitotomia Percutânea , Ácido Tranexâmico , Transfusão de Sangue , Humanos , Duração da Cirurgia , Estudos Prospectivos
12.
West Afr J Med ; Vol. 38(11): 1088-1094, 2021 Nov 30.
Artigo em Inglês | MEDLINE | ID: mdl-34922408

RESUMO

BACKGROUND: Blood transfusion therapy remains a mainstay in the care of many tropical diseases. Blood supply in sub-Saharan Africa (SSA) including Nigeria is still a challenge in terms of perennial blood shortages and transfusion transmissible infections (TTI). This study aimed to describe blood donation patterns and compare the rates of TTIs among types of blood donors seen at LUTH. STUDY METHOD: A 6-year retrospective review of data on donor types and pattern of TTIs at LUTH transfusion service. TTI rates and odd ratios (OR) of TTI positivity amongst VNRD versus FRD were computed at 95% confidence intervals. Proportion of TTI sero-positivity was also compared between the VNRD and FRD groups. RESULTS: A total of 53,319 blood donors were observed over the study period, with average of 8886.5 donors per year. VNRDs accounted for 12.3% (6533/53,319), while FRDs accounted for 87.7% (46,789/53,319) of all donors. The proportion of VNRDs ranged from 5.1% to 20.8%. The overall prevalence of TTIs over the 6-year period for all donors was 1.34% for HIV, 5.79% for HBV, 2.23% for HCV and 0.88% for syphilis. Sero-positivity rates for HIV, HBV, HCV, and syphilis was statistically significantly lower among VNRD compared to FRDs. CONCLUSION: There exists a lot of room for improvement in our blood donation practices to improve blood stock and transfusion safety. A more aggressive strategic effort needs to be directed towards achieving a target of 100% voluntary blood donor base through partnerships, advocacy, more financing and resource allocation, and other proven initiatives.


Assuntos
Doadores de Sangue , Transfusão de Sangue , Hospitais , Humanos , Nigéria , Estudos Retrospectivos
13.
BMJ Open Qual ; 10(4)2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34930719

RESUMO

A perioperative patient blood management (PBM) educational intervention was implemented for first year postgraduate doctors (interns) at the Royal Brisbane and Women's Hospital (RBWH) following identification of a perioperative PBM training requirement. This quality improvement activity evaluated the effectiveness of this educational intervention in improving intern knowledge of perioperative PBM principles.A 15-question perioperative PBM focused multiple choice questionnaire developed from information attained from comprehensive, evidence and consensus-based guidelines regarding PBM practice was distributed to interns immediately before a compulsory perioperative PBM educational intervention and then again 5 weeks later. The perioperative PBM educational intervention was delivered every 10 weeks (five interventions in total) to a different group of interns each time. Statistical analysis determined significance between mean questionnaire score before and after the intervention.The mean pre-intervention score for correctly answered questions was 7/15 (SD 2.73) and mean post-intervention score was 9/15 (SD 2.99) (p=0.02). Categorisation of questions into core domains of perioperative PBM demonstrated intern scores for correctly answered questions improved in all domains following the educational intervention.Perioperative PBM education delivered through a dedicated intervention aimed to improve knowledge is associated with objective evidence of educational benefits for interns at RBWH. It is an effective strategy to enact PBM governance and bestow clinical guideline knowledge. This is important given the global health sector's challenge to improve patient outcomes despite increasingly restricted funding and pressure on doctors to devote more time to service and less to teaching.


Assuntos
Competência Clínica , Melhoria de Qualidade , Transfusão de Sangue , Feminino , Humanos
14.
J Spec Oper Med ; 21(4): 94-98, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34969135

RESUMO

The US Military Tactical Combat Casualty Care guidelines recommend blood products as the preferred means of fluid resuscitation in trauma patients;, however, most combat units do not receive blood products prior to executing combat operations. This is largely due to logistical limitations in both blood supply and transfusion equipment. Further, the vast majority of medics are not trained in transfusion protocol. For many medics, the logistical constraints for cold-stored blood products favor the use of Walking Blood Bank (WBB), however few cases have been reported of WBB implementation at the point of injury during real world combat operations. This case report reviews one case of successful transfusion using WBB procedures at point of injury during combat. It highlights not only the feasibility, but also the necessity, for implementation of this practice on a larger scale.


Assuntos
Medicina Militar , Militares , Bancos de Sangue , Transfusão de Sangue , Humanos , Ressuscitação
16.
Immunohematology ; 37(4): 160-164, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34964314

RESUMO

Individuals with the rare para-Bombay phenotype have inherited defects in producing H associated with FUT1 and/or FUT2 genes. We report a case of blood group discrepancy in a para-Bombay patient from a tertiary care hospital of eastern India. A 31-year-old woman with rheumatic heart disease presented with fatigue and breathlessness and was then scheduled for valvuloplasty, for which a blood transfusion request was sent to the blood center. During pre-transfusion testing, red blood cell (RBC) testing showed group O, and serum testing showed strong reactivity with group B RBCs, weak reactivity with group O RBCs, and very weak reactivity with group A RBCs. Saliva inhibition testing and enzyme treatment of RBCs concluded the patient to be of "Ah para-Bombay" phenotype. The patient's Lewis phenotype was Le(a-b+). This patient's serum also had cold-reacting anti-IH along with anti-B. This case report highlights the importance of performing an advanced immunohematologic workup, including adsorption, elution, enzyme treatment, and saliva inhibition testing for identification of weak A or B subgroups as well as the rare para-Bombay blood group, when routine ABO typing, using forward and reverse grouping, is inconclusive. Accurate identification of blood group helps in preventing transfusion-related adverse events and encouraging safe transfusion practice.Individuals with the rare para-Bombay phenotype have inherited defects in producing H associated with FUT1 and/or FUT2 genes. We report a case of blood group discrepancy in a para-Bombay patient from a tertiary care hospital of eastern India. A 31-year-old woman with rheumatic heart disease presented with fatigue and breathlessness and was then scheduled for valvuloplasty, for which a blood transfusion request was sent to the blood center. During pre-transfusion testing, red blood cell (RBC) testing showed group O, and serum testing showed strong reactivity with group B RBCs, weak reactivity with group O RBCs, and very weak reactivity with group A RBCs. Saliva inhibition testing and enzyme treatment of RBCs concluded the patient to be of "Ah para-Bombay" phenotype. The patient's Lewis phenotype was Le(a­b+). This patient's serum also had cold-reacting anti-IH along with anti-B. This case report highlights the importance of performing an advanced immunohematologic workup, including adsorption, elution, enzyme treatment, and saliva inhibition testing for identification of weak A or B subgroups as well as the rare para-Bombay blood group, when routine ABO typing, using forward and reverse grouping, is inconclusive. Accurate identification of blood group helps in preventing transfusion-related adverse events and encouraging safe transfusion practice.


Assuntos
Sistema ABO de Grupos Sanguíneos , Tipagem e Reações Cruzadas Sanguíneas , Sistema ABO de Grupos Sanguíneos/genética , Adulto , Transfusão de Sangue , Eritrócitos , Feminino , Fucosiltransferases/genética , Humanos , Fenótipo
17.
J Spec Oper Med ; 21(4): 11-21, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34969121

RESUMO

This Clinical Practice Guideline (CPG) provides a brief summary of the scientific literature for prehospital blood use, with an emphasis on the en route care environment. Updates include the importance of calcium administration to counteract the deleterious effects of hypocalcemia, minimal to no use of crystalloid, and stresses the importance of involved and educated en route care medical directors alongside at a competent prehospital and en route care providers (see Table 1). With the paradigm shift to use FDA-approved cold stored low titer group O whole blood (CS-LTOWB) along with the operational need for continued use of walking blood banks (WBB) and point of injury (POI) transfusion, there must be focused, deliberate training incorporating the different whole blood options. Appropriate supervision of autologous blood transfusion training is important for execution of this task in support of deployed combat operations as well as other operations in which traumatic injuries will occur. Command emphasis on the importance of this effort as well as appropriate logistical support are essential elements of a prehospital blood program as part of a prehospital/en route combat casualty care system.


Assuntos
Serviços Médicos de Emergência , Ferimentos e Lesões , Bancos de Sangue , Transfusão de Sangue , Soluções Cristaloides , Humanos , Ressuscitação , Ferimentos e Lesões/terapia
18.
Anesthesiol Clin ; 39(4): 597-611, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34776099

RESUMO

Obstetric hemorrhage is a leading cause of morbidity and mortality. Prevention includes identifying patients with risk factors and actively managing the third stage of labor. The anesthesiologist should be ready to manage hemorrhage with general strategies as well as strategies tailored to the specific cause of hemorrhage. Both neuraxial anesthesia and general anesthesia are appropriate in different situations. Treatments proven to be effective include increasing the oxytocin infusion, administering tranexamic acid early, guiding transfusion with point-of-care tests, and using cell salvage. Utilization of protocols and checklists within systems that encourage effective communication between teams should be implemented.


Assuntos
Hemorragia Pós-Parto , Transfusão de Sangue , Feminino , Humanos , Ocitocina , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Fatores de Risco
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