Patients with gastrointestinal bleeding often require large volume blood transfusion. Among the various side effects of blood transfusion,the increase of potassium levels is a serious one which is often overlooked. We...Patients with gastrointestinal bleeding often require large volume blood transfusion. Among the various side effects of blood transfusion,the increase of potassium levels is a serious one which is often overlooked. We report a case of severe hyperkalemia in a patient with gastric bleeding after large volume transfusion of packed red blood cells. The patient had hyperkalemia at baseline associated with his receiving medication as well as acute renal failure following hypovolemia. The baseline hyperkalemia was further aggravated after massive transfusions of packed red blood cells in a short period of time. The associated pathogenetic mechanisms resulting in the increase of potassium levels are presented. A number of risk factors which increase the risk of hyperkalemia after blood transfusion are discussed. Moreover,appropriate management strategies for the prevention of blood transfusion associated hyperkalemia are also presented. Physicians should always keep in mind the possibility of hyperkalemia in cases of blood transfusion.展开更多
AIM To determine if packed red blood cell transfusions contribute to the development of parenteral nutrition associated liver disease. METHODS A retrospective chart review of 49 premature infants on parenteral nutriti...AIM To determine if packed red blood cell transfusions contribute to the development of parenteral nutrition associated liver disease. METHODS A retrospective chart review of 49 premature infants on parenteral nutrition for > 30 d who received packed red blood cell(PRBC) transfusions was performed. Parenteral nutrition associated liver disease was primarily defined by direct bilirubin(db) > 2.0 mg/dL. A high transfusion cohort was defined as receiving > 75 mL packed red blood cells(the median value). KaplanMeier plots estimated the median volume of packedred blood cells received in order to develop parenteral nutrition associated liver disease.RESULTS Parenteral nutritional associated liver disease(PNALD) was noted in 21(43%) infants based on db. Among the 27 high transfusion infants, PNALD was present in 17(64%) based on elevated direct bilirubin which was significantly greater than the low transfusion recipients. About 50% of the infants, who were transfused 101-125 mL packed red blood cells, developed PNALD based on elevation of direct bilirubin. All infants who were transfused more than 200 mL of packed red blood cells developed PNALD. Similar results were seen when using elevation of aspartate transaminase or alanine transaminase to define PNALD.CONCLUSION In this retrospective, pilot study there was a statistically significant correlation between the volume of PRBC transfusions received by premature infants and the development of PNALD.展开更多
As one of the main factors affecting safe blood transfusion, hepatitis B virus(HBV) infection through blood transfer seriously endangers human health. Therefore, studies should focus on both reducing infection rate of...As one of the main factors affecting safe blood transfusion, hepatitis B virus(HBV) infection through blood transfer seriously endangers human health. Therefore, studies should focus on both reducing infection rate of HBV and accurately evaluating the risk of infection. This study discusses the main factors affecting HBV infection that results from blood transfusions, with the aim of gaining insights into reducing HBV infection.展开更多
Background: Hip arthroplasty is a surgery with a high risk of bleeding. The main objective of this study was to research risk factors for bleeding and transfusion in patients undergoing hip arthroplasty in order to gu...Background: Hip arthroplasty is a surgery with a high risk of bleeding. The main objective of this study was to research risk factors for bleeding and transfusion in patients undergoing hip arthroplasty in order to guide a blood-saving program. Method: Retrospective, monocentric, descriptive and analytical study carried out from June 2011 to June 2021 at the Omar Bongo Ondimba army training hospital. The variables studied were demographic characteristics, biological variables, transfusion data, anesthetic and intraoperative data. The primary outcome was intraoperative or postoperative transfusion. A univariate and multivariate analysis was conducted to identify the factors associated with the occurrence of a transfusion. Results: Of the 276 patients included, 179 benefited from Total Hip Prosthesis (THP) and 97 from Intermediate Hip Prosthesis (IHP). Spinal anesthesia was performed in 67.4% of patients. The ASA 2 score predominated (65.9%). The transfusion incidence was 56.9% (157/276). Tranexamic acid was used in 16.3% (45/276) of patients. The average bleeding was 528 ± 405 ml. Preoperative anemia (OR = 0.78, 95% CI [0.66 - 0.91]) and total hip prosthesis (OR = 2.02 95% CI [1.11 - 3.67]) were predictors of bleeding and transfusion to be significant. The average serum hemoglobin predictive of a transfusion was 11.6 ± 1.8. ASA score and operative time were not found as risk factors for bleeding and transfusion. Conclusion: The incidence of transfusion is high. Preoperative anemia remains a major but modifiable risk factor unlike the choice of implant. The implementation of a patient blood management protocol could reduce this transfusion incidence.展开更多
BACKGROUND Transfusion transmissible infections(TTIs)are illnesses spread through contaminated blood or blood products.In India,screening for TTIs such as hepatitis B virus(HBV),hepatitis C virus(HCV),human immunodefi...BACKGROUND Transfusion transmissible infections(TTIs)are illnesses spread through contaminated blood or blood products.In India,screening for TTIs such as hepatitis B virus(HBV),hepatitis C virus(HCV),human immunodeficiency virus(HIV)-I/II,malaria,and syphilis is mandatory before blood transfusions.Worldwide,HCV,HBV,and HIV are the leading viruses causing mortality,affecting millions of people globally,including those with co-infections of HIV/HCV and HIV/HBV.Studies highlight the impact of TTIs on life expectancy and health risks,such as liver cirrhosis,cancer,and other diseases in individuals with chronic HBV.Globally,millions of blood donations take place annually,emphasizing the importance of maintaining blood safety.AIM To study the prevalence of TTIs,viz.,HBV,HCV,HIV I/II,syphilis,and malaria parasite(MP),among different blood donor groups.METHODS The study assessed the prevalence of TTIs among different blood donor groups in Delhi,India.Groups included total donors,in-house donors,total camp donors,institutional camp donors,and community camp donors.Tests for HIV,HBV,and HCV were done using enzyme-linked immunosorbent assay,while syphilis was tested with rapid plasma reagins and MP rapid card methods.The prevalence of HBV,HCV,HIV,and syphilis,expressed as percentages.Differences in infection rates between the groups were analyzed usingχ²tests and P-values(less than 0.05).RESULTS The study evaluated TTIs among 42158 blood donors in Delhi.The overall cumulative frequency of TTIs in total blood donors was 2.071%,and the frequencies of HBV,HCV,HIV-I/II,venereal disease research laboratory,and MP were 1.048%,0.425%,0.221%,0.377%,and 0.0024%,respectively.In-house donors,representing 37656 donors,had the highest transfusion transmissible infection(TTI)prevalence at 2.167%.Among total camp donors(4502 donors),TTIs were identified in 1.266%of donors,while community camp donors(2439 donors)exhibited a prevalence of 1.558%.Institutional camp donors(2063 donors)had the lowest TTI prevalence at 0.921%.Statistical analysis revealed significant differences in overall TTI prevalence,with total and in-house donors exhibiting higher rates compared to camp donors.CONCLUSION Ongoing monitoring and effective screening programs are essential for minimizing TTIs.Customizing blood safety measures for different donor groups and studying socio-economic-health factors is essential to improving blood safety.展开更多
Beta thalassemia(β-thalassemia)syndromes are a heterogeneous group of inherited hemoglobinopathies caused by molecular defects in the beta-globin gene that lead to the impaired synthesis of beta-globin chains of the ...Beta thalassemia(β-thalassemia)syndromes are a heterogeneous group of inherited hemoglobinopathies caused by molecular defects in the beta-globin gene that lead to the impaired synthesis of beta-globin chains of the hemoglobin.The hallmarks of the disease include ineffective erythropoiesis,chronic hemolytic anemia,and iron overload.Clinical presentation ranges from asymptomatic carriers to severe anemia requiring lifelong blood transfusions with subsequent devastating complications.The management of patients with severeβ-thalassemia represents a global health problem,particularly in low-income countries.Until recently,management strategies were limited to regular transfusions and iron chelation therapy,with allogeneic hematopoietic stem cell transplantation available only for a subset of patients.Better understanding of the underlying pathophysiological mechanisms ofβ-thalassemia syndromes and associated clinical phenotypes has paved the way for novel therapeutic options,including pharmacologic enhancers of effective erythropoiesis and gene therapy.展开更多
Background:Undifferentiated shock is recognized as a criticality state that is transitional in immune-mediated topology for casual risk of lethal microcirculatory dysfunction.This was a sensitivity analysis of a drug(...Background:Undifferentiated shock is recognized as a criticality state that is transitional in immune-mediated topology for casual risk of lethal microcirculatory dysfunction.This was a sensitivity analysis of a drug(tetracosactide;TCS10)targeting melanocortin receptors(MCRs)in a phase 3 randomized controlled trial to improve cardiovascular surgical rescue outcome by reversing mortality and hemostatic disorders.Methods:Sensitivity analysis was based on a randomized,two-arm,multicenter,double-blind,controlled trial.The Naïve Bayes classifier was performed by density-based sensitivity index for principal strata as proportional hazard model of 30-day surgical risk mortality according to European System for Cardiac Operative Risk Evaluation inputs outputs in 100 consecutive cases(from August to September 2013 from Emilia Romagna region,Italy).Patients included an agent-based TCS10 group(10 mg,single intravenous bolus before surgery;n=56)and control group(n=44)and the association with cytokines,lactate,and bleeding-blood transfusion episodes with the prior-risk log odds for mortality rate in time-to-event was analyzed.Results:Thirty-day mortality was significantly improved in the TCS10 group vs.control group(0 vs.8 deaths,P<0.0001).Baseline levels of interleukin(IL)-6,IL-10,and lactate were associated with bleeding episodes,independent of TCS10 treatment[odds ratio(OR)=1.90,95%confidence interval(CI)1.39-2.79;OR=1.53,95%CI 1.17-2.12;and OR=2.92,95%CI 1.40-6.66,respectively],while baseline level of Fms-like tyrosine kinase 3 ligand(Flt3L)was associated with lower bleeding rates in TCS10-treated patients(OR=0.31,95%CI 0.11-0.90,P=0.03).For every 8 TCS10-treated patients,1 bleeding case was avoided.Blood transfusion episodes were significantly reduced in the TCS10 group compared to the control group(OR=0.32,95%CI 0.14-0.73,P=0.01).For every 4 TCS10-treated patients,1 transfusion case was avoided.Conclusions:Sensitivity index underlines the quality target product profile of TCS10 in the runway of emergency casualty care.To introduce the technology readiness level in real-life critically ill patients,further large-scale studies are required.Trial registration:European Union Drug Regulating Authorities Clinical Trials Database(EudraCT Number:2007-006445-41).展开更多
BACKGROUND Hypertriglyceridemia thalassemia syndrome is a rare condition that occurs in patients with thalassemia.It typically presents with a combination of profound anemia and milky serum.Although previous case seri...BACKGROUND Hypertriglyceridemia thalassemia syndrome is a rare condition that occurs in patients with thalassemia.It typically presents with a combination of profound anemia and milky serum.Although previous case series have demonstrated the benefit of blood transfusions in reducing serum triglycerides,information regar-ding clinical outcomes and standard management in this setting remains limited.AIM To identify the clinical course,treatment strategies,and outcomes of patients with hypertriglyceridemia thalassemia syndrome.METHODS We performed a comprehensive search of the Scopus,PubMed,and Embase databases.We included only English-language articles and did not apply any publication date limits.The databases were last accessed on September 1,2024.This study was registered under number CRD420250587918 and included studies involving children and adults with thalassemia,hypertriglyceridemia,and available data on clinical course.RESULTS A total of 14 publications were included in the analysis,all of which were case reports or case series.No higher-quality evidence was available.Among 28 children with hypertriglyceridemia thalassemia syndrome,there were 22 cases ofβ-thalassemia major and 6 cases of hemoglobin E/β-thalassemia,including our illustrative case.The median age of onset was 11 months,and 92.3%of cases presented prior to the first blood transfusion.The common clinical manifestations included pallor(100%)and hepatosplenomegaly(67.9%).For hypertriglyceridemia-related symptoms,lipemia retinalis and xanthomas were observed in 25.0%and 10.7%of cases,respectively.The median hemoglobin level was 5.5 g/dL,while the median triglyceride level was 935 mg/dL.For management,92.9%of cases received blood transfusions with or without other interventions.At a median of 12 months’follow-up,all patients responded to the treatment without lipid-lowering agents,and 85.7%of cases were alive.CONCLUSION Hypertriglyceridemia thalassemia syndrome occurs exclusively in young children and usually presents with anemia and severe hypertriglyceridemia prior to the first transfusion.Management with blood transfusions provides a favorable response.However,long-term regular monitoring is warranted.展开更多
BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as...BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as a potential alternative,offe-ring reduced trauma and faster recovery.This meta-analysis compares the effi-cacy and safety of robotic surgery vs conventional sternotomy for cardiac myxo-ma excision.We hypothesized that robotic surgery would provide comparable safety outcomes with improved postoperative recovery,such as shorter hospital stays and reduced transfusion rates,despite potentially longer operative times.METHODS A systematic review was performed using EMBASE,OVID,Scopus,PubMed,Cochrane,and ScienceDirect databases to identify studies comparing robotic surgery and sternotomy for cardiac myxoma excision.Continuous outcomes were analyzed using mean differences(MDs),and categorical outcomes with odds ratios(ORs)and 95%confidence intervals(95%CIs).A random-effects model was used to pool data,accounting for study heterogeneity.RESULTS Six studies involving 425 patients(180 robotic,245 conventional)were included.Robotic surgery significantly increased cross-clamp time(MD=12.03 minutes,95%CI:2.14-21.92,P=0.02)and cardiopulmonary bypass time(MD=28.37 minutes,95%CI:11.85-44.89,P=0.001).It reduced hospital stay(MD=-1.86 days,95%CI:-2.45 to-1.27,P<0.00001)and blood transfusion requirements(OR=0.30,95%CI:0.13-0.69,P=0.007).No significant differences were observed in atrial arrhythmia(OR=0.55,95%CI:0.27-1.12)or ventilation time(MD=-1.72 hours,95%CI:-5.27 to 1.83,P=0.34).CONCLUSION Robotic surgery for cardiac myxoma excision prolongs operative times but shortens hospital stays and reduces transfusion needs,suggesting enhanced recovery without compromising safety.展开更多
Introduction: Human pegivirus (HPgV), initially identified as hepatitis G virus in the 1990s, predominantly causes acute hepatitis and may persist particularly in individuals with compromised immune systems or those c...Introduction: Human pegivirus (HPgV), initially identified as hepatitis G virus in the 1990s, predominantly causes acute hepatitis and may persist particularly in individuals with compromised immune systems or those co-infected with HIV, HBV, or HCV. Despite its potential public health implications, particularly in transfusion contexts, comprehensive epidemiological data on HPgV in Burkina Faso remains scarce. Objectives: This study aimed to determine 1) the prevalence of human pegivirus infection among blood donors at the Regional Blood Transfusion Centre (Koudougou, Burkina Faso), and 2) the rates of co-infection between human pegivirus with HIV, HBV, HCV and Treponema pallidum. Material and Methods: Between 9 and 27 August 2022, 100 blood samples were collected and analyzed at the Regional Blood Transfusion Centre. Screening for HIV, HBV, HCV, and Treponema pallidum was conducted using the Cobas e 601 system (Roche Diagnostics). A 100 μL volume of each donor’s plasma was utilized for viral RNA extraction with the DNA/RNA Prep Kit (Sacace Biotechnologies) following the manufacturer’s instructions. HPgV RNA detection was conducted using the HGV Real-TM amplification kit (Sacace Biotechnologies). Results: The study was comprised of 100 blood donors, identifying HPgV RNA in 14 individuals (14% prevalence), with one noted co-infection with HBV. None of the participants were HIV positive. The prevalence rates for HBV and HCV were each found to be 5%, and syphilis also presented a prevalence of 5%. Conclusion: Our findings indicate a significant prevalence of HPgV among blood donors in Burkina Faso, underscoring the need for heightened surveillance and preventive measures in blood transfusion services and the broader population to enhance transfusion safety and public health.展开更多
Background: Blood transfusion (BT) is crucial to the provision of modern health care. However, blood is scarce and costly, and its use is associated with risks. Therefore, the medical professionals who handle it shoul...Background: Blood transfusion (BT) is crucial to the provision of modern health care. However, blood is scarce and costly, and its use is associated with risks. Therefore, the medical professionals who handle it should have adequate knowledge to ensure rational and safe utilization. The objective of the study was to determine the level of BT knowledge among junior medical doctors in Kenya. Methodology: A cross-sectional study was conducted among junior medical doctors working in Western Kenya. Data was collected using questionnaires from August 2021 to March 2022, and analysis was done by way of descriptive and inferential statistics. A p Results: A total of 150 medical doctors participated in the study. Males comprised 60% (n = 90), and the mean age of the participants was 29.9 (SD 3.6) with a range of 25 - 45 years. The mean knowledge score was 54.1% ± 16.4% and was associated with orientation (AOR = 3.157, 95% CI = 1.194 - 8.337). Conclusion: Blood transfusion knowledge among the doctors was suboptimal and was associated with pre-internship induction. There is a need for additional education in BT during all phases of medical training and practice, including orientation for medical interns.展开更多
BACKGROUND There is an ongoing debate regarding the relationship between intraoperative blood transfusions and patient outcomes.Unifying the results is difficult because of differences in surgery type,target populatio...BACKGROUND There is an ongoing debate regarding the relationship between intraoperative blood transfusions and patient outcomes.Unifying the results is difficult because of differences in surgery type,target population and postoperative observation indicators.AIM To evaluate the risk factors for intraoperative blood transfusion and its impact on postoperative outcomes in elderly gastrointestinal cancer patients.METHODS This was a retrospective single-center study of elderly patients(≥65 years old)who underwent elective abdominal surgery for gastrointestinal cancer with general anesthesia.Patients with chronic kidney disease and missing related data were excluded.The primary outcomes included acute kidney injury(AKI),myocardial injury,and respiratory complications during hospitalization.Multivariate logistic regression was performed to explore the exposure-outcome relationship.RESULTS A total of 967 patients were included in this study.A lower preoperative hematocrit level,longer operative time(>300 minutes)and greater amount of blood loss were observed in 145(15.0%)patients who received blood transfusions during surgery(P<0.0005).Among these patients,the incidences of AKI,myocardial injury and respiratory complications were 8.3%(n=12),5.5%(n=8),and 15.9%(n=23),respectively,and these values were significantly greater.Multivariate analysis revealed that receiving a transfusion was an independent risk factor for AKI,myocardial injury and respiratory complications(all P<0.05).CONCLUSION These results demonstrate that intraoperative blood transfusion increases the risk of poorer outcomes in elderly patients receiving gastrointestinal cancer surgery.These findings provide new ideas for improving the prognosis of elderly cancer patients.展开更多
The Rh blood group system,especially the D antigen,is crucial in transfusion medicine and obstetrics.Weak D phenotypes,caused by mutations in the Rhesus D antigen(RhD)blood group(RHD)gene,result in reduced antigen exp...The Rh blood group system,especially the D antigen,is crucial in transfusion medicine and obstetrics.Weak D phenotypes,caused by mutations in the Rhesus D antigen(RhD)blood group(RHD)gene,result in reduced antigen expression,posing challenges in serological testing and clinical management.Variability in detection methods leads to inconsistent results,making accurate classification difficult.Molecular techniques like polymerase chain reaction and DNA sequencing have significantly improved the identification of weak D variants,offering more reliable transfusion strategies and reducing the risk of alloimmunization.However,challenges such as lack of standardized protocols,cost constraints,and population-specific variations remain.In obstetrics,proper management of pregnant women with weak D is essential to prevent hemolytic disease of the fetus and newborn.Non-invasive prenatal testing using cell-free fetal DNA shows promise in predicting RhD incompatibility and minimizing unnecessary Rh immune globulin administration.Future advancements in highthroughput genotyping and discovery of novel RHD alleles could enhance RhD testing accuracy and efficiency.Standardizing RHD genotyping and adopting genotype-based management strategies for Rh immune globulin therapy and red blood cell transfusions will improve patient safety and clinical outcomes.This review examines the molecular basis,challenges,and future prospects in weak D phenotype management.展开更多
Background： The reports on massive transfusions （MTs） in obstetrics have recently been an increasing trend. We aimed to define the clinical features, risk factors, main causes, and outcomes of MTs due to severe pos...Background： The reports on massive transfusions （MTs） in obstetrics have recently been an increasing trend. We aimed to define the clinical features, risk factors, main causes, and outcomes of MTs due to severe postpartum hemorrhage （PPH） and the frequency trends over the past 10 years. Methods： We retrospectively analyzed the data of 3552 PPH patients who were at ≥28 weeks of gestation in the Obstetric Department of Peking University First Hospital from January 2006 to February 2015. The clinical records of patients receiving MT with ≥5 units （approximately 1000 ml） of red blood cells within 24 h of giving birth were included. The Pearson＇s Chi-square and Fisher＇s exact tests were used to compare the frequency distributions among the categorical variables of the clinical features. Results： One-hundred six women were identified with MT over the 10-year period. The MT percentage was stable between the first 5-year group （2006-2010） and the second 5-year group （2011-2015） （2.5‰ vs. 2.7‰, χ^2 = 154.85, P = 0.25）. Although uterine atony remained the main cause of MT, there was a rising trend for placental abnormalities （especially placenta accreta） in the second 5-year group compared with the first 5-year group （34% vs. 23%, χ^2 = 188.26, P = 0.03）. Twenty-four （23%） women underwent hysterectomy, and among all the causes of PPH, placenta accreta had the highest hysterectomy rate of 70% （17/24）. No maternal death was observed. Conclusions： There was a rising trend for placental abnormalities underlying the stable incidence of MT in the PPH cases. Placenta accreta accounted for the highest risk of hysterectomy. It is reasonable to have appropriate blood transfusion backup for high-risk patients, especially those with placenta accreta.展开更多
To the Editor:Unstable clinical conditions and complications make multiple laboratory tests and blood sampling inevitable in preterm infants,contributing to iatrogenic blood loss.Undoubtedly,iatrogenic blood loss is h...To the Editor:Unstable clinical conditions and complications make multiple laboratory tests and blood sampling inevitable in preterm infants,contributing to iatrogenic blood loss.Undoubtedly,iatrogenic blood loss is highly correlated with red blood cell transfusion(RBCT).A previous study on extremely low birth weight(BW)infants reported that the sampling blood loss was 30.0 mL/kg within the first week of life,leading to one or more RBCTs in 98%of patients.[1]RBCTs are increasingly reported to cause inflammatory responses and increase the incidence of preterm complications.Therefore,reducing iatrogenic blood loss could not only decrease the need for transfusions but also reduce the risk of neonatal mortality and morbidity.展开更多
Background:Bleeding and need for red blood cell transfusions(RBCT)remain a significant concern with hepatectomy.RBCT carry risk of transfusion-related immunomodulation that may impact post-operative recovery.This stud...Background:Bleeding and need for red blood cell transfusions(RBCT)remain a significant concern with hepatectomy.RBCT carry risk of transfusion-related immunomodulation that may impact post-operative recovery.This study soughs to assess the association between RBCT and post-hepatectomy morbidity.Methods:Using the American College of Surgeons National Surgical Quality Improvement Program(ACS-NSQIP)registry,we identified all adult patients undergoing elective hepatectomy over 2007–2012.Two exposure groups were created based on RBCT.Primary outcomes were 30-day major morbidity and mortality.Secondary outcomes included 30-day system-specific morbidity and length of stay(LOS).Relative risks(RR)with 95%confidence interval(95%CI)were computed using regression analyses.Sensitivity analyses were conducted to understand how missing data might have impacted the results.Results:A total of 12,180 patients were identified.Of those,11,712 met inclusion criteria,2,951(25.2%)of whom received RBCT.Major morbidity occurred in 14.9%of patients and was strongly associated with RBCT(25.3%vs.11.3%;P<0.001).Transfused patients had higher rates of 30-day mortality(5.6%vs.1.0%;P<0.0001).After adjustment for baseline and clinical characteristics,RBCT was independently associated with increased major morbidity(RR 1.80;95%CI:1.61–1.99),mortality(RR 3.62;95%CI:2.68–4.89),and 1.29 times greater LOS(RR 1.29;95%CI:1.25–1.32).Results were robust to a number of sensitivity analyses for missing data.Conclusions:Perioperative RBCT for hepatectomy was independently associated with worse short-term outcomes and prolonged LOS.These findings further the rationale to focus on minimizing RBCT for hepatectomy,when they can be avoided.展开更多
Background:Increased risks have been found for patients undergoing liver transplantation due to the blood supply shortage following the ongoing coronavirus disease 2019(COVID-19)pandemic.Hence,exploring a method to al...Background:Increased risks have been found for patients undergoing liver transplantation due to the blood supply shortage following the ongoing coronavirus disease 2019(COVID-19)pandemic.Hence,exploring a method to alleviate this dilemma is urgent.This phase I,nonrandomized,prospective trial aimed to evaluate the safety and feasibility of using donor-specific red blood cell transfusion(DRBCT)as an urgent measurement to alleviate the blood supply shortage in deceased donor liver transplantation(DDLT).Methods:The outcomes of 26 patients who received DRBCT and 37 patients in the control group who only received 3rd party packed red blood cells(pRBCs)transfusion between May 2020 and January 2021 were compared.Results:Patients receiving DRBCT did not develop transfusion-related complications,and the incidence of postoperative infection was similar to that in the control group(23.1%vs.18.9%,P=0.688).Because the patients received the red blood cells from organ donors,the median volume of intraoperative allogeneic red blood cell transfusion from blood bank was 4.0 U(IQR 1.1-8.0 U)in the DRBCT group,which is significantly lower than that(7.5 U,IQR 4.0-10.0 U)in the control group(P=0.018).The peak aspartate aminotransferase(AST)level was significantly lower in the DRBCT group than in the control group(P=0.008)and so were the AST levels in the first two days after the operation(P=0.006 and P=0.033).Conclusions:DRBCT is a safe and effective procedure to lower the need for blood supply and is associated with a reduction in AST levels after transplantation.DRBCT is beneficial to patients receiving life-saving transplantation without sufficient blood supply during the COVID-19 pandemic.展开更多
BACKGROUND Cesarean hemorrhage is one of the serious complications,and short-term massive blood transfusion can easily cause postoperative infection and physical stress response.However,predictive nursing intervention...BACKGROUND Cesarean hemorrhage is one of the serious complications,and short-term massive blood transfusion can easily cause postoperative infection and physical stress response.However,predictive nursing intervention has important clinical significance for it.AIM To explore the effect of predictive nursing intervention on the stress response and complications of women undergoing short-term mass blood transfusion during cesarean section(CS).METHODS A clinical medical record of 100 pregnant women undergoing rapid mass blood transfusion during sections from June 2019 to June 2021.According to the different nursing methods,patients divided into control group(n=50)and observation group(n=50).Among them,the control group implemented routine nursing,and the observation group implemented predictive nursing intervention based on the control group.Moreover,compared the differences in stress res-ponse,complications,and pain scores before and after the nursing of pregnant women undergoing rapid mass blood transfusion during CS.RESULTS The anxiety and depression scores of pregnant women in the two groups were significantly improved after nursing,and the psychological stress response of the observation group was significantly lower than that of the control group(P<0.05).The heart rate and mean arterial pressure(MAP)of the observation group during delivery were lower than those of the control group,and the MAP at the end of delivery was lower than that of the control group(P<0.05).Moreover,different pain scores improved significantly in both groups,with the observation group considerably less than the control group(P<0.05).After nursing,complications such as skin rash,urinary retention,chills,diarrhea,and anaphylactic shock in the observation group were 18%,which significantly higher than in the control group(4%)(P<0.05).CONCLUSION Predictive nursing intervention can effectively relieve the pain,reduce the incidence of complications,improve mood and stress response,and serve as a reference value for the nursing of women undergoing rapid mass transfusion during CS.展开更多
Background:Exercise training promotes brain plasticity and is associated with protection against cognitive impairment and Alzheimer’s disease(AD).These beneficial effects may be partly mediated by blood-borne factors...Background:Exercise training promotes brain plasticity and is associated with protection against cognitive impairment and Alzheimer’s disease(AD).These beneficial effects may be partly mediated by blood-borne factors.Here we used an in vitro model of AD to investigate effects of blood plasma from exercise-trained donors on neuronal viability,and an in vivo rat model of AD to test whether such plasma impacts cognitive function,amyloid pathology,and neurogenesis.Methods:Mouse hippocampal neuronal cells were exposed to AD-like stress using amyloid-βand treated with plasma collected from human male donors 3 h after a single bout of high-intensity exercise.For in vivo studies,blood was collected from exercise-trained young male Wistar rats(high-intensity intervals 5 days/week for 6 weeks).Transgenic AD rats(McGill-R-Thyl-APP)were inj ected 5 times/fortnight for 6 weeks at2 months or 5 months of age with either(a)plasma from the exercise-trained rats,(b)plasma from sedentary rats,or(c)saline.Cognitive function,amyloid plaque pathology,and neurogenesis were assessed.The plasma used for the treatment was analyzed for 23 cytokines.Results:Plasma from exercised donors enhanced cell viability by 44.1%(p=0.032)and reduced atrophy by 50.0%(p<0.001)in amyloid-β-treated cells.In vivo exercised plasma treatment did not alter cognitive function or amyloid plaque pathology but did increase hippocampal neurogenesis by~3 fold,regardless of pathological stage,when compared to saline-treated rats.Concentrations of 7 cytokines were significantly reduced in exercised plasma compared to sedentary plasma.Conclusion:Our proof-of-concept study demonstrates that plasma from exercise-trained donors can protect neuronal cells in culture and promote adult hippocampal neurogenesis in the AD rat brain.This effect may be partly due to reduced pro-inflammatory signaling molecules in exercised plasma.展开更多
文摘Patients with gastrointestinal bleeding often require large volume blood transfusion. Among the various side effects of blood transfusion,the increase of potassium levels is a serious one which is often overlooked. We report a case of severe hyperkalemia in a patient with gastric bleeding after large volume transfusion of packed red blood cells. The patient had hyperkalemia at baseline associated with his receiving medication as well as acute renal failure following hypovolemia. The baseline hyperkalemia was further aggravated after massive transfusions of packed red blood cells in a short period of time. The associated pathogenetic mechanisms resulting in the increase of potassium levels are presented. A number of risk factors which increase the risk of hyperkalemia after blood transfusion are discussed. Moreover,appropriate management strategies for the prevention of blood transfusion associated hyperkalemia are also presented. Physicians should always keep in mind the possibility of hyperkalemia in cases of blood transfusion.
文摘AIM To determine if packed red blood cell transfusions contribute to the development of parenteral nutrition associated liver disease. METHODS A retrospective chart review of 49 premature infants on parenteral nutrition for > 30 d who received packed red blood cell(PRBC) transfusions was performed. Parenteral nutrition associated liver disease was primarily defined by direct bilirubin(db) > 2.0 mg/dL. A high transfusion cohort was defined as receiving > 75 mL packed red blood cells(the median value). KaplanMeier plots estimated the median volume of packedred blood cells received in order to develop parenteral nutrition associated liver disease.RESULTS Parenteral nutritional associated liver disease(PNALD) was noted in 21(43%) infants based on db. Among the 27 high transfusion infants, PNALD was present in 17(64%) based on elevated direct bilirubin which was significantly greater than the low transfusion recipients. About 50% of the infants, who were transfused 101-125 mL packed red blood cells, developed PNALD based on elevation of direct bilirubin. All infants who were transfused more than 200 mL of packed red blood cells developed PNALD. Similar results were seen when using elevation of aspartate transaminase or alanine transaminase to define PNALD.CONCLUSION In this retrospective, pilot study there was a statistically significant correlation between the volume of PRBC transfusions received by premature infants and the development of PNALD.
文摘As one of the main factors affecting safe blood transfusion, hepatitis B virus(HBV) infection through blood transfer seriously endangers human health. Therefore, studies should focus on both reducing infection rate of HBV and accurately evaluating the risk of infection. This study discusses the main factors affecting HBV infection that results from blood transfusions, with the aim of gaining insights into reducing HBV infection.
文摘Background: Hip arthroplasty is a surgery with a high risk of bleeding. The main objective of this study was to research risk factors for bleeding and transfusion in patients undergoing hip arthroplasty in order to guide a blood-saving program. Method: Retrospective, monocentric, descriptive and analytical study carried out from June 2011 to June 2021 at the Omar Bongo Ondimba army training hospital. The variables studied were demographic characteristics, biological variables, transfusion data, anesthetic and intraoperative data. The primary outcome was intraoperative or postoperative transfusion. A univariate and multivariate analysis was conducted to identify the factors associated with the occurrence of a transfusion. Results: Of the 276 patients included, 179 benefited from Total Hip Prosthesis (THP) and 97 from Intermediate Hip Prosthesis (IHP). Spinal anesthesia was performed in 67.4% of patients. The ASA 2 score predominated (65.9%). The transfusion incidence was 56.9% (157/276). Tranexamic acid was used in 16.3% (45/276) of patients. The average bleeding was 528 ± 405 ml. Preoperative anemia (OR = 0.78, 95% CI [0.66 - 0.91]) and total hip prosthesis (OR = 2.02 95% CI [1.11 - 3.67]) were predictors of bleeding and transfusion to be significant. The average serum hemoglobin predictive of a transfusion was 11.6 ± 1.8. ASA score and operative time were not found as risk factors for bleeding and transfusion. Conclusion: The incidence of transfusion is high. Preoperative anemia remains a major but modifiable risk factor unlike the choice of implant. The implementation of a patient blood management protocol could reduce this transfusion incidence.
文摘BACKGROUND Transfusion transmissible infections(TTIs)are illnesses spread through contaminated blood or blood products.In India,screening for TTIs such as hepatitis B virus(HBV),hepatitis C virus(HCV),human immunodeficiency virus(HIV)-I/II,malaria,and syphilis is mandatory before blood transfusions.Worldwide,HCV,HBV,and HIV are the leading viruses causing mortality,affecting millions of people globally,including those with co-infections of HIV/HCV and HIV/HBV.Studies highlight the impact of TTIs on life expectancy and health risks,such as liver cirrhosis,cancer,and other diseases in individuals with chronic HBV.Globally,millions of blood donations take place annually,emphasizing the importance of maintaining blood safety.AIM To study the prevalence of TTIs,viz.,HBV,HCV,HIV I/II,syphilis,and malaria parasite(MP),among different blood donor groups.METHODS The study assessed the prevalence of TTIs among different blood donor groups in Delhi,India.Groups included total donors,in-house donors,total camp donors,institutional camp donors,and community camp donors.Tests for HIV,HBV,and HCV were done using enzyme-linked immunosorbent assay,while syphilis was tested with rapid plasma reagins and MP rapid card methods.The prevalence of HBV,HCV,HIV,and syphilis,expressed as percentages.Differences in infection rates between the groups were analyzed usingχ²tests and P-values(less than 0.05).RESULTS The study evaluated TTIs among 42158 blood donors in Delhi.The overall cumulative frequency of TTIs in total blood donors was 2.071%,and the frequencies of HBV,HCV,HIV-I/II,venereal disease research laboratory,and MP were 1.048%,0.425%,0.221%,0.377%,and 0.0024%,respectively.In-house donors,representing 37656 donors,had the highest transfusion transmissible infection(TTI)prevalence at 2.167%.Among total camp donors(4502 donors),TTIs were identified in 1.266%of donors,while community camp donors(2439 donors)exhibited a prevalence of 1.558%.Institutional camp donors(2063 donors)had the lowest TTI prevalence at 0.921%.Statistical analysis revealed significant differences in overall TTI prevalence,with total and in-house donors exhibiting higher rates compared to camp donors.CONCLUSION Ongoing monitoring and effective screening programs are essential for minimizing TTIs.Customizing blood safety measures for different donor groups and studying socio-economic-health factors is essential to improving blood safety.
文摘Beta thalassemia(β-thalassemia)syndromes are a heterogeneous group of inherited hemoglobinopathies caused by molecular defects in the beta-globin gene that lead to the impaired synthesis of beta-globin chains of the hemoglobin.The hallmarks of the disease include ineffective erythropoiesis,chronic hemolytic anemia,and iron overload.Clinical presentation ranges from asymptomatic carriers to severe anemia requiring lifelong blood transfusions with subsequent devastating complications.The management of patients with severeβ-thalassemia represents a global health problem,particularly in low-income countries.Until recently,management strategies were limited to regular transfusions and iron chelation therapy,with allogeneic hematopoietic stem cell transplantation available only for a subset of patients.Better understanding of the underlying pathophysiological mechanisms ofβ-thalassemia syndromes and associated clinical phenotypes has paved the way for novel therapeutic options,including pharmacologic enhancers of effective erythropoiesis and gene therapy.
基金funded by the National Plan Military Research (EF a2011.188)
文摘Background:Undifferentiated shock is recognized as a criticality state that is transitional in immune-mediated topology for casual risk of lethal microcirculatory dysfunction.This was a sensitivity analysis of a drug(tetracosactide;TCS10)targeting melanocortin receptors(MCRs)in a phase 3 randomized controlled trial to improve cardiovascular surgical rescue outcome by reversing mortality and hemostatic disorders.Methods:Sensitivity analysis was based on a randomized,two-arm,multicenter,double-blind,controlled trial.The Naïve Bayes classifier was performed by density-based sensitivity index for principal strata as proportional hazard model of 30-day surgical risk mortality according to European System for Cardiac Operative Risk Evaluation inputs outputs in 100 consecutive cases(from August to September 2013 from Emilia Romagna region,Italy).Patients included an agent-based TCS10 group(10 mg,single intravenous bolus before surgery;n=56)and control group(n=44)and the association with cytokines,lactate,and bleeding-blood transfusion episodes with the prior-risk log odds for mortality rate in time-to-event was analyzed.Results:Thirty-day mortality was significantly improved in the TCS10 group vs.control group(0 vs.8 deaths,P<0.0001).Baseline levels of interleukin(IL)-6,IL-10,and lactate were associated with bleeding episodes,independent of TCS10 treatment[odds ratio(OR)=1.90,95%confidence interval(CI)1.39-2.79;OR=1.53,95%CI 1.17-2.12;and OR=2.92,95%CI 1.40-6.66,respectively],while baseline level of Fms-like tyrosine kinase 3 ligand(Flt3L)was associated with lower bleeding rates in TCS10-treated patients(OR=0.31,95%CI 0.11-0.90,P=0.03).For every 8 TCS10-treated patients,1 bleeding case was avoided.Blood transfusion episodes were significantly reduced in the TCS10 group compared to the control group(OR=0.32,95%CI 0.14-0.73,P=0.01).For every 4 TCS10-treated patients,1 transfusion case was avoided.Conclusions:Sensitivity index underlines the quality target product profile of TCS10 in the runway of emergency casualty care.To introduce the technology readiness level in real-life critically ill patients,further large-scale studies are required.Trial registration:European Union Drug Regulating Authorities Clinical Trials Database(EudraCT Number:2007-006445-41).
文摘BACKGROUND Hypertriglyceridemia thalassemia syndrome is a rare condition that occurs in patients with thalassemia.It typically presents with a combination of profound anemia and milky serum.Although previous case series have demonstrated the benefit of blood transfusions in reducing serum triglycerides,information regar-ding clinical outcomes and standard management in this setting remains limited.AIM To identify the clinical course,treatment strategies,and outcomes of patients with hypertriglyceridemia thalassemia syndrome.METHODS We performed a comprehensive search of the Scopus,PubMed,and Embase databases.We included only English-language articles and did not apply any publication date limits.The databases were last accessed on September 1,2024.This study was registered under number CRD420250587918 and included studies involving children and adults with thalassemia,hypertriglyceridemia,and available data on clinical course.RESULTS A total of 14 publications were included in the analysis,all of which were case reports or case series.No higher-quality evidence was available.Among 28 children with hypertriglyceridemia thalassemia syndrome,there were 22 cases ofβ-thalassemia major and 6 cases of hemoglobin E/β-thalassemia,including our illustrative case.The median age of onset was 11 months,and 92.3%of cases presented prior to the first blood transfusion.The common clinical manifestations included pallor(100%)and hepatosplenomegaly(67.9%).For hypertriglyceridemia-related symptoms,lipemia retinalis and xanthomas were observed in 25.0%and 10.7%of cases,respectively.The median hemoglobin level was 5.5 g/dL,while the median triglyceride level was 935 mg/dL.For management,92.9%of cases received blood transfusions with or without other interventions.At a median of 12 months’follow-up,all patients responded to the treatment without lipid-lowering agents,and 85.7%of cases were alive.CONCLUSION Hypertriglyceridemia thalassemia syndrome occurs exclusively in young children and usually presents with anemia and severe hypertriglyceridemia prior to the first transfusion.Management with blood transfusions provides a favorable response.However,long-term regular monitoring is warranted.
文摘BACKGROUND Cardiac myxoma,a benign intracardiac tumor,is traditionally excised via conven-tional sternotomy,which is invasive and associated with longer recovery times.Minimally invasive robotic surgery has emerged as a potential alternative,offe-ring reduced trauma and faster recovery.This meta-analysis compares the effi-cacy and safety of robotic surgery vs conventional sternotomy for cardiac myxo-ma excision.We hypothesized that robotic surgery would provide comparable safety outcomes with improved postoperative recovery,such as shorter hospital stays and reduced transfusion rates,despite potentially longer operative times.METHODS A systematic review was performed using EMBASE,OVID,Scopus,PubMed,Cochrane,and ScienceDirect databases to identify studies comparing robotic surgery and sternotomy for cardiac myxoma excision.Continuous outcomes were analyzed using mean differences(MDs),and categorical outcomes with odds ratios(ORs)and 95%confidence intervals(95%CIs).A random-effects model was used to pool data,accounting for study heterogeneity.RESULTS Six studies involving 425 patients(180 robotic,245 conventional)were included.Robotic surgery significantly increased cross-clamp time(MD=12.03 minutes,95%CI:2.14-21.92,P=0.02)and cardiopulmonary bypass time(MD=28.37 minutes,95%CI:11.85-44.89,P=0.001).It reduced hospital stay(MD=-1.86 days,95%CI:-2.45 to-1.27,P<0.00001)and blood transfusion requirements(OR=0.30,95%CI:0.13-0.69,P=0.007).No significant differences were observed in atrial arrhythmia(OR=0.55,95%CI:0.27-1.12)or ventilation time(MD=-1.72 hours,95%CI:-5.27 to 1.83,P=0.34).CONCLUSION Robotic surgery for cardiac myxoma excision prolongs operative times but shortens hospital stays and reduces transfusion needs,suggesting enhanced recovery without compromising safety.
文摘Introduction: Human pegivirus (HPgV), initially identified as hepatitis G virus in the 1990s, predominantly causes acute hepatitis and may persist particularly in individuals with compromised immune systems or those co-infected with HIV, HBV, or HCV. Despite its potential public health implications, particularly in transfusion contexts, comprehensive epidemiological data on HPgV in Burkina Faso remains scarce. Objectives: This study aimed to determine 1) the prevalence of human pegivirus infection among blood donors at the Regional Blood Transfusion Centre (Koudougou, Burkina Faso), and 2) the rates of co-infection between human pegivirus with HIV, HBV, HCV and Treponema pallidum. Material and Methods: Between 9 and 27 August 2022, 100 blood samples were collected and analyzed at the Regional Blood Transfusion Centre. Screening for HIV, HBV, HCV, and Treponema pallidum was conducted using the Cobas e 601 system (Roche Diagnostics). A 100 μL volume of each donor’s plasma was utilized for viral RNA extraction with the DNA/RNA Prep Kit (Sacace Biotechnologies) following the manufacturer’s instructions. HPgV RNA detection was conducted using the HGV Real-TM amplification kit (Sacace Biotechnologies). Results: The study was comprised of 100 blood donors, identifying HPgV RNA in 14 individuals (14% prevalence), with one noted co-infection with HBV. None of the participants were HIV positive. The prevalence rates for HBV and HCV were each found to be 5%, and syphilis also presented a prevalence of 5%. Conclusion: Our findings indicate a significant prevalence of HPgV among blood donors in Burkina Faso, underscoring the need for heightened surveillance and preventive measures in blood transfusion services and the broader population to enhance transfusion safety and public health.
文摘Background: Blood transfusion (BT) is crucial to the provision of modern health care. However, blood is scarce and costly, and its use is associated with risks. Therefore, the medical professionals who handle it should have adequate knowledge to ensure rational and safe utilization. The objective of the study was to determine the level of BT knowledge among junior medical doctors in Kenya. Methodology: A cross-sectional study was conducted among junior medical doctors working in Western Kenya. Data was collected using questionnaires from August 2021 to March 2022, and analysis was done by way of descriptive and inferential statistics. A p Results: A total of 150 medical doctors participated in the study. Males comprised 60% (n = 90), and the mean age of the participants was 29.9 (SD 3.6) with a range of 25 - 45 years. The mean knowledge score was 54.1% ± 16.4% and was associated with orientation (AOR = 3.157, 95% CI = 1.194 - 8.337). Conclusion: Blood transfusion knowledge among the doctors was suboptimal and was associated with pre-internship induction. There is a need for additional education in BT during all phases of medical training and practice, including orientation for medical interns.
基金Supported by the National Natural Science Foundation of China,No.81901999the Natural Science Foundation of Shanghai Municipality,No.23ZR1410900Wu Jieping Medical Foundation,No.320.6750.2024-05-47.
文摘BACKGROUND There is an ongoing debate regarding the relationship between intraoperative blood transfusions and patient outcomes.Unifying the results is difficult because of differences in surgery type,target population and postoperative observation indicators.AIM To evaluate the risk factors for intraoperative blood transfusion and its impact on postoperative outcomes in elderly gastrointestinal cancer patients.METHODS This was a retrospective single-center study of elderly patients(≥65 years old)who underwent elective abdominal surgery for gastrointestinal cancer with general anesthesia.Patients with chronic kidney disease and missing related data were excluded.The primary outcomes included acute kidney injury(AKI),myocardial injury,and respiratory complications during hospitalization.Multivariate logistic regression was performed to explore the exposure-outcome relationship.RESULTS A total of 967 patients were included in this study.A lower preoperative hematocrit level,longer operative time(>300 minutes)and greater amount of blood loss were observed in 145(15.0%)patients who received blood transfusions during surgery(P<0.0005).Among these patients,the incidences of AKI,myocardial injury and respiratory complications were 8.3%(n=12),5.5%(n=8),and 15.9%(n=23),respectively,and these values were significantly greater.Multivariate analysis revealed that receiving a transfusion was an independent risk factor for AKI,myocardial injury and respiratory complications(all P<0.05).CONCLUSION These results demonstrate that intraoperative blood transfusion increases the risk of poorer outcomes in elderly patients receiving gastrointestinal cancer surgery.These findings provide new ideas for improving the prognosis of elderly cancer patients.
文摘The Rh blood group system,especially the D antigen,is crucial in transfusion medicine and obstetrics.Weak D phenotypes,caused by mutations in the Rhesus D antigen(RhD)blood group(RHD)gene,result in reduced antigen expression,posing challenges in serological testing and clinical management.Variability in detection methods leads to inconsistent results,making accurate classification difficult.Molecular techniques like polymerase chain reaction and DNA sequencing have significantly improved the identification of weak D variants,offering more reliable transfusion strategies and reducing the risk of alloimmunization.However,challenges such as lack of standardized protocols,cost constraints,and population-specific variations remain.In obstetrics,proper management of pregnant women with weak D is essential to prevent hemolytic disease of the fetus and newborn.Non-invasive prenatal testing using cell-free fetal DNA shows promise in predicting RhD incompatibility and minimizing unnecessary Rh immune globulin administration.Future advancements in highthroughput genotyping and discovery of novel RHD alleles could enhance RhD testing accuracy and efficiency.Standardizing RHD genotyping and adopting genotype-based management strategies for Rh immune globulin therapy and red blood cell transfusions will improve patient safety and clinical outcomes.This review examines the molecular basis,challenges,and future prospects in weak D phenotype management.
文摘Background： The reports on massive transfusions （MTs） in obstetrics have recently been an increasing trend. We aimed to define the clinical features, risk factors, main causes, and outcomes of MTs due to severe postpartum hemorrhage （PPH） and the frequency trends over the past 10 years. Methods： We retrospectively analyzed the data of 3552 PPH patients who were at ≥28 weeks of gestation in the Obstetric Department of Peking University First Hospital from January 2006 to February 2015. The clinical records of patients receiving MT with ≥5 units （approximately 1000 ml） of red blood cells within 24 h of giving birth were included. The Pearson＇s Chi-square and Fisher＇s exact tests were used to compare the frequency distributions among the categorical variables of the clinical features. Results： One-hundred six women were identified with MT over the 10-year period. The MT percentage was stable between the first 5-year group （2006-2010） and the second 5-year group （2011-2015） （2.5‰ vs. 2.7‰, χ^2 = 154.85, P = 0.25）. Although uterine atony remained the main cause of MT, there was a rising trend for placental abnormalities （especially placenta accreta） in the second 5-year group compared with the first 5-year group （34% vs. 23%, χ^2 = 188.26, P = 0.03）. Twenty-four （23%） women underwent hysterectomy, and among all the causes of PPH, placenta accreta had the highest hysterectomy rate of 70% （17/24）. No maternal death was observed. Conclusions： There was a rising trend for placental abnormalities underlying the stable incidence of MT in the PPH cases. Placenta accreta accounted for the highest risk of hysterectomy. It is reasonable to have appropriate blood transfusion backup for high-risk patients, especially those with placenta accreta.
基金supported by a grant from the National Natural Science Foundation of China(Nos.82271749 and 82171710).
文摘To the Editor:Unstable clinical conditions and complications make multiple laboratory tests and blood sampling inevitable in preterm infants,contributing to iatrogenic blood loss.Undoubtedly,iatrogenic blood loss is highly correlated with red blood cell transfusion(RBCT).A previous study on extremely low birth weight(BW)infants reported that the sampling blood loss was 30.0 mL/kg within the first week of life,leading to one or more RBCTs in 98%of patients.[1]RBCTs are increasingly reported to cause inflammatory responses and increase the incidence of preterm complications.Therefore,reducing iatrogenic blood loss could not only decrease the need for transfusions but also reduce the risk of neonatal mortality and morbidity.
文摘Background:Bleeding and need for red blood cell transfusions(RBCT)remain a significant concern with hepatectomy.RBCT carry risk of transfusion-related immunomodulation that may impact post-operative recovery.This study soughs to assess the association between RBCT and post-hepatectomy morbidity.Methods:Using the American College of Surgeons National Surgical Quality Improvement Program(ACS-NSQIP)registry,we identified all adult patients undergoing elective hepatectomy over 2007–2012.Two exposure groups were created based on RBCT.Primary outcomes were 30-day major morbidity and mortality.Secondary outcomes included 30-day system-specific morbidity and length of stay(LOS).Relative risks(RR)with 95%confidence interval(95%CI)were computed using regression analyses.Sensitivity analyses were conducted to understand how missing data might have impacted the results.Results:A total of 12,180 patients were identified.Of those,11,712 met inclusion criteria,2,951(25.2%)of whom received RBCT.Major morbidity occurred in 14.9%of patients and was strongly associated with RBCT(25.3%vs.11.3%;P<0.001).Transfused patients had higher rates of 30-day mortality(5.6%vs.1.0%;P<0.0001).After adjustment for baseline and clinical characteristics,RBCT was independently associated with increased major morbidity(RR 1.80;95%CI:1.61–1.99),mortality(RR 3.62;95%CI:2.68–4.89),and 1.29 times greater LOS(RR 1.29;95%CI:1.25–1.32).Results were robust to a number of sensitivity analyses for missing data.Conclusions:Perioperative RBCT for hepatectomy was independently associated with worse short-term outcomes and prolonged LOS.These findings further the rationale to focus on minimizing RBCT for hepatectomy,when they can be avoided.
基金This study was supported by grants from the New Clinical Technology Project,West China Hospital,Sichuan University(Grant number:20HXJS012)Sichuan Province Key Research and Development Project(Grant number:2020YFS0134)National Clinical Research Center for Geriatrics,West China Hospital,Sichuan University(Grant number:Z2018B23).
文摘Background:Increased risks have been found for patients undergoing liver transplantation due to the blood supply shortage following the ongoing coronavirus disease 2019(COVID-19)pandemic.Hence,exploring a method to alleviate this dilemma is urgent.This phase I,nonrandomized,prospective trial aimed to evaluate the safety and feasibility of using donor-specific red blood cell transfusion(DRBCT)as an urgent measurement to alleviate the blood supply shortage in deceased donor liver transplantation(DDLT).Methods:The outcomes of 26 patients who received DRBCT and 37 patients in the control group who only received 3rd party packed red blood cells(pRBCs)transfusion between May 2020 and January 2021 were compared.Results:Patients receiving DRBCT did not develop transfusion-related complications,and the incidence of postoperative infection was similar to that in the control group(23.1%vs.18.9%,P=0.688).Because the patients received the red blood cells from organ donors,the median volume of intraoperative allogeneic red blood cell transfusion from blood bank was 4.0 U(IQR 1.1-8.0 U)in the DRBCT group,which is significantly lower than that(7.5 U,IQR 4.0-10.0 U)in the control group(P=0.018).The peak aspartate aminotransferase(AST)level was significantly lower in the DRBCT group than in the control group(P=0.008)and so were the AST levels in the first two days after the operation(P=0.006 and P=0.033).Conclusions:DRBCT is a safe and effective procedure to lower the need for blood supply and is associated with a reduction in AST levels after transplantation.DRBCT is beneficial to patients receiving life-saving transplantation without sufficient blood supply during the COVID-19 pandemic.
文摘BACKGROUND Cesarean hemorrhage is one of the serious complications,and short-term massive blood transfusion can easily cause postoperative infection and physical stress response.However,predictive nursing intervention has important clinical significance for it.AIM To explore the effect of predictive nursing intervention on the stress response and complications of women undergoing short-term mass blood transfusion during cesarean section(CS).METHODS A clinical medical record of 100 pregnant women undergoing rapid mass blood transfusion during sections from June 2019 to June 2021.According to the different nursing methods,patients divided into control group(n=50)and observation group(n=50).Among them,the control group implemented routine nursing,and the observation group implemented predictive nursing intervention based on the control group.Moreover,compared the differences in stress res-ponse,complications,and pain scores before and after the nursing of pregnant women undergoing rapid mass blood transfusion during CS.RESULTS The anxiety and depression scores of pregnant women in the two groups were significantly improved after nursing,and the psychological stress response of the observation group was significantly lower than that of the control group(P<0.05).The heart rate and mean arterial pressure(MAP)of the observation group during delivery were lower than those of the control group,and the MAP at the end of delivery was lower than that of the control group(P<0.05).Moreover,different pain scores improved significantly in both groups,with the observation group considerably less than the control group(P<0.05).After nursing,complications such as skin rash,urinary retention,chills,diarrhea,and anaphylactic shock in the observation group were 18%,which significantly higher than in the control group(4%)(P<0.05).CONCLUSION Predictive nursing intervention can effectively relieve the pain,reduce the incidence of complications,improve mood and stress response,and serve as a reference value for the nursing of women undergoing rapid mass transfusion during CS.
基金funded by The Norwegian Research Council,the Liaison Committee between the Central Norway Regional Health Authorityfunded by the Coordination for the Improvement of Higher Education PersonnelBrazil(Capes)。
文摘Background:Exercise training promotes brain plasticity and is associated with protection against cognitive impairment and Alzheimer’s disease(AD).These beneficial effects may be partly mediated by blood-borne factors.Here we used an in vitro model of AD to investigate effects of blood plasma from exercise-trained donors on neuronal viability,and an in vivo rat model of AD to test whether such plasma impacts cognitive function,amyloid pathology,and neurogenesis.Methods:Mouse hippocampal neuronal cells were exposed to AD-like stress using amyloid-βand treated with plasma collected from human male donors 3 h after a single bout of high-intensity exercise.For in vivo studies,blood was collected from exercise-trained young male Wistar rats(high-intensity intervals 5 days/week for 6 weeks).Transgenic AD rats(McGill-R-Thyl-APP)were inj ected 5 times/fortnight for 6 weeks at2 months or 5 months of age with either(a)plasma from the exercise-trained rats,(b)plasma from sedentary rats,or(c)saline.Cognitive function,amyloid plaque pathology,and neurogenesis were assessed.The plasma used for the treatment was analyzed for 23 cytokines.Results:Plasma from exercised donors enhanced cell viability by 44.1%(p=0.032)and reduced atrophy by 50.0%(p<0.001)in amyloid-β-treated cells.In vivo exercised plasma treatment did not alter cognitive function or amyloid plaque pathology but did increase hippocampal neurogenesis by~3 fold,regardless of pathological stage,when compared to saline-treated rats.Concentrations of 7 cytokines were significantly reduced in exercised plasma compared to sedentary plasma.Conclusion:Our proof-of-concept study demonstrates that plasma from exercise-trained donors can protect neuronal cells in culture and promote adult hippocampal neurogenesis in the AD rat brain.This effect may be partly due to reduced pro-inflammatory signaling molecules in exercised plasma.
