[Preoperative blood ordering in elective colon surgery: requirement or routine?]. / Solicitud de sangre preoperatoria en cirugía programada de colon: ¿necesidad o rutina?

BACKGROUND: Preoperative blood ordering is frequently in elective colon surgery, even for procedures that rarely require blood transfusion. Most often this procedure is performed without proper analysis of the real needs. The aim of this study was to evaluate the patients who receive transfusion and determining their associated factors. METHODS: Retrospective study of all consecutive patients scheduled for elective colon surgery was carried out at 2007-2012. Several clinico-pathological and surgical variables were analyzed and predictive blood transfusion indices such as the cross-matched/transfusion ratio (C/T ratio), transfusion index and transfusion probability were calculated. Patients were divided in 2 groups according have received perioperative surgical transfusion or not. RESULTS: There were 457 surgery patients. A total of 171 blood units, in a 74 patients were perioperative transfused. Overall cross-matched transfused ratio was 5.34, the transfusion probability 162%, and the transfusion index 0.18. Variables that were significantly associated with receiving blood transfusion in a multivariable analysis were a preoperative haemoglobin level less than 10 g/dl (OR: 309.8; 95% CI: 52.7-985.2), chronic pulmonary obstructive disease (OR: 3.7; 95% CI: 1.3-10.7), oral anticoagulant therapy (OR: 5.7; 95% CI: 1.7-19.4) and surgical time over 120 min (OR: 10.7; 95% CI: 4.7-24.1). CONCLUSIONS: Likelihood of receiving perioperative transfusion in elective colon surgery is very low. Among their associated factors, the haemoglobin level less than 10 g/dl is the one with strongest association. Those patients with such low preoperative haemoglobin level should not be scheduled for elective colon surgery until they received specific treatment.

Relationship between the ABO blood group and COVID-19 susceptibility, severity and mortality in two cohorts of patients.

BACKGROUND: Several articles reported the existence of an association between ABO blood groups and COVID-19 susceptibility. Group A and group O individuals showed a higher and lower risk, respectively, of becoming infected. No association was observed between ABO groups and mortality. To verify this association, we performed a retrospective study of two cohorts of patients with different demographic and clinical characteristics. MATERIAL AND METHODS: A total of 854 regular blood donors were recruited for convalescent plasma donation after recovering from a mild COVID-19 infection, and a group of 965 patients more severely affected who were transfused during hospitalisation were also included. We also investigated the potential role of the different risk factors on patient outcome and death. To eliminate the confounding effect of risk factors on mortality, a propensity score analysis was performed. RESULTS: Blood group A and blood group O COVID-19 blood donors showed a higher and lower risk, respectively, for acquiring COVID-19. In contrast, this association was not found in the group of patients transfused during hospitalisation, probably due to the great differences in demographic and clinical characteristics between the two groups. Regarding severity, age was one of the most significant risk factors. ABO blood groups were also seen to represent important risk factors for COVID-19 severity and mortality. Mortality risk in group A individuals was significantly higher than in group O individuals (OR: 1.75, 95% CI: 1.22-2.51). DISCUSSION: The association between the ABO blood groups and the susceptibility to acquire COVID-19 infection was confirmed in the group of blood donors. ABO blood groups were also associated to COVID-19 severity and mortality in the group of patients transfused during hospitalisation. Therefore, blood groups A and O are two important factors to be considered when evaluating the prognosis of patients with COVID-19.

Efficacy in reducing potassium load in irradiated red cell bags with a potassium adsorption filter.

BACKGROUND: The transfusion of red cell (RBC) bags with high amounts of potassium (K(+)) causes concern about an increased risk of cardiac arrest because of transient hyperkalemia. To prevent K(+) overload, a K(+) adsorption filter (PAF) is available for use at bedside. The aim of the present study was to analyze the efficacy in reducing K(+) load in irradiated RBC bags with this PAF. STUDY DESIGN AND METHODS: Whole-blood (WB) bags were collected from volunteer donors on Day 0. RBC bags were prepared from WB bags on Day +1 and stored at 2 to 6 degrees C. RBC bags were irradiated on Day +14 and filtered with the PAF on Day +28, according to the manufacturers' instructions. The plasma electrolyte levels (Na(+), K(+), Cl(-), Ca(2+), and Mg(2+)) were measured at the different points during storage. RESULTS: Twelve RBC bags were prepared with a final volume of 274 +/- 15 mL. On Day +28, the volume of RBC bags was 257 +/- 15 mL, and the PAF was used at a flow rate of 4 +/- 0.7 mL per minute. K(+) level after RBC bag preparation was 1.28 +/- 0.59 mmol per L. The K(+) level was 60.6 +/- 2.68 mmol per L on Day +28, just before filtration with the PAF. After filtration, the level of K(+) was 3.42 +/- 2.91 mmol per L. CONCLUSION: This study has shown a high efficacy in reducing potassium load in irradiated RBC bags with the use of the PAF.

Quantitative and qualitative analysis of proteins in fresh frozen plasma obtained from whole blood donations and prepared with two photochemical treatments.

Thirty-six fresh frozen plasma (FFP) units obtained from whole blood donations were used for 12 replicate experiments. For each replicate experiment, three ABO-matched FFP units were pooled and divided into three units containing different volumes of identical plasma. One unit was used as control FFP, one unit was treated with methylene blue plus visible light and one unit was treated with amotosalen and UVA light. The overall coagulation factor levels were better maintained in untreated FFP than in photochemically treated plasma. However, treated-plasma by both photochemical methods maintained coagulation factor levels that met or exceeded the European Pharmacopeia requirements for therapeutic plasma.

Long-term results of thalidomide in refractory and relapsed multiple myeloma with emphasis on response duration.

OBJECTIVE: Thalidomide administered as a single agent produces a response rate of about 40% in patients with refractory or relapsed multiple myeloma (MM). The aim of our study was to determine the quality and duration of such responses. PATIENTS AND METHODS: Forty-two consecutive patients with refractory (20) or relapsed (22) MM were given thalidomide as a single agent at our institution. Most of them (70%) had previously received two or more lines of therapy, and 38% had undergone autologous stem cell transplantation. RESULTS: Eighteen patients (43%) responded to thalidomide [11 minimal responses (MR) and seven partial responses (PR)] according to the European Marrow Transplant Registry (EBMT) criteria. The median time to response was 3 months and the median duration of therapy in responding patients was 9 months. Treatment was discontinued because of toxicity in 10 responding patients. The toxicity mainly led to peripheral neuropathy and fatigue. At the time of this analysis, all responding patients had progressed except one who remains in continued stable PR. The median time to progression was 15.6 months (range 1.3 to 70+), with a trend towards a longer duration for patients who achieved PR vs. MR (21.2 vs. 11.2 months, P = 0.11). The median duration of response was 12.4 months (range: 0.3-67+) (17.2 months for PR vs. 9.7 months for MR, P = 0.11). CONCLUSION: These results show that the effect of thalidomide in refractory/relapsed MM can be sustained, particularly in patients who achieve a greater degree of response, and support the finding that this drug can be used for maintenance therapy.

Case-control comparison of at-home to total hospital care for autologous stem-cell transplantation for hematologic malignancies.

PURPOSE: One of the most significant limitations of at-home autologous stem-cell transplantation (ASCT) is the necessity for hospital readmission. We developed an at-home ASCT program in which prophylactic ceftriaxone and treatment of febrile neutropenia with piperacillin and tazobactam was introduced to minimize the readmission rate. PATIENTS AND METHODS: Between November 2000 and February 2005, 178 consecutive patients underwent ASCT for a hematologic malignancy. Of these, 50 patients fulfilled the requirements for at-home ASCT. Results were compared with those observed in a control group of 50 patients individually matched to the group of patients treated at home for age, sex, diagnosis, stage of disease, conditioning, and source of stem cells. RESULTS: Febrile neutropenia occurred in fewer patients in the at-home group as compared with the hospitalized group (76% v 96%: P = .008), and duration of fever was also shorter in the at-home group (median, 2 and 6 days, respectively; range, 1 to 11 and 1 to 20 days, respectively; P = .00003). Hospital readmission in the at-home group was required in only four cases (8%). This resulted in a reduction of 18.6 days of hospitalization per patient. Likewise, total median charges were approximately half in the at-home group as compared with the in-hospital group (3,345 euro v 6,250 euro, respectively; P < .00001). CONCLUSION: Results of at-home ASCT with prophylactic administration of ceftriaxone and domiciliary treatment of febrile neutropenia with piperacillin and tazobactam are highly satisfactory and significantly cheaper compared with those obtained with conventional in-hospital ASCT.