ABSTRACT
Background: In liver cirrhosis anemia occurs in up to 75 percent of the patients and blood transfusion is the mainstay of treatment of anemia. Red cell alloimmunization is a common problem encountered in multi-transfused patient. Alloimmunization can make further blood transfusion troublesome as extensive matching of donor is required to provide antigen free blood to the recipient for which alloantibodies are formed. Antibodies to foreign red cell antigens in patient's blood results in delay of transfusion because of complex pre-transfusion tests and difficulty in finding compatible red blood cell unit. Moreover, they can also cause delayed hemolytic blood transfusion reaction
Objectives: 1] To determine frequency of red blood cell alloantibodies in multi-transfused liver cirrhosis patient. 2] To determine the specific type of most common alloantibodies in multi-transfused liver cirrhosis patient
Study design: Cross-sectional study
Place of study: Pathology department of King Edward Medical University with sampling from four hospitals located in Lahore, Pakistan: Mayo Hospital, Jinnah Hospital, Services Hospital and Sir Ganga Ram Hospital
Period of study: January 2016 to March 2016
Methodology: To establish alloimmunization rate in multi-transfused liver cirrhosis patient, cross-sectional study was designed. Sample size of 90 liver cirrhosis patients of all age groups and both genders who had been transfused at least 5 times were taken with the exclusion criteria of known alloantibodies or autoimmune diseases. Patients were screened for alloantibodies using tube IAT and if found positive specific type of antibody was determined using extended red cell panel
Results: 90 patients were screened for alloantibodies of which 3 patients were positive for alloantibodies giving alloimmunization rate of 3.3 percent in multi-transfused liver cirrhosis patient. All three patients had antibodies of different specificities. First patient had anti-D, second patient had anti- Le[b] belonging to Lewis blood group system and third patient had Anti-Jk[a] belonging to Kidd blood group system
Conclusions: This study was conducted to explore the frequency of alloimmunization in multi-transfused liver cirrhosis patients. Due to cross-sectional study design, incidence of formation of new antibodies as well as loss of antibodies over time could not be determined. Therefore, to establish red blood cell alloimmunization rate in cirrhotic patient, a large-scale prospective study should be done in which LISS IAT or enzyme treated cell should be used and antibody detection tests should be done at defined time intervals after blood transfusion. It is suggested that antibody screening test should be done twice. Once shortly after blood transfusion [may be after one month] to detect fast appearing new antibodies or anamnestic response of undetectable antibodies. Secondly after longer interval to detect slow evolving antibodies
ABSTRACT
Background: antibiotic administration is an essential element for any surgical operation success, even if a prior infection was not detected. This is due to the fact that antimicrobial agents do not only act as therapy to treat preexisting infection but also as a prophylaxis which is given preoperatively to reduce the incidence of surgical site infection and as an adjunct to operative treatment which is given in the setting of operative management of infections such as secondary peritonitis or necrotizing fasciitis. Prophylactic antibiotics are also used as primary therapy when operation is not performed, such as for cellulitis, or postoperative pneumonia which indicates the significance of surgical antibiotic prophylaxis and the great importance of adhering to the right treatment protocol and guidelines
Aim of the Study: a systematic review was performed to evaluate the adherence to clinical guidelines for surgical antibiotic prophylaxis
Methods: of which fifteen studies were retrieved that fulfilled most of the inclusion requirements of being randomized controlled clinical trials
Results: 952 articles were retrieved from database, of which 15 studies were selected for selected for synthesis. 5 outcome of interest were identified, on top of which were the administration of antibiotic at the correct time and adequate discontinuation of antibiotic which ranged from 0.3% to 100%
Conclusion: the assessed studies addressed a gap in the adherence to guidelines for surgical antibiotic prophylaxis and more rigor approaches to leverage the guidelines
ABSTRACT
Background: postoperative peritoneal adhesions are common and frequent complication following abdominal and Pelvic Surgery. Adhesions can lead to bowel obstructions and infertility in women [when they develop around the reproductive organs], chronic pain which consequently results in reducing the quality of life for patients, level of energy, productivity, and increase the risk, complexity and chance of complications in subsequent surgeries. Main objective of this review is to study the implication of using the?good surgical techniques' in the prevention of postoperative adhesions
Methods: the present review included randomized controlled trials [RCTs] that investigated the different surgical technique impact on adhesion-related outcomes were identified through search in Pubmed, CENTRAL and Embase. Identified endpoints were: clinical outcomes and incidence of adhesions. The primary Identification of papers and data extraction were performed by independent researchers
Results: out of 1709 studies, there were only 21 papers eligible for a systematic review and included in the meta-analysis and qualitative assessment. None of the techniques that were compared significantly reduced the incidence of adhesive small bowel obstruction. In a small low-quality trial, the pregnancy rate increased after subserous fixation of suture knots. However, the incidence of adhesions was lower after laparoscopic compared with open surgery [relative risk [RR] 0.14; 95% confidence interval [CI]: 0.03-0.61] and when the peritoneum was not closed [RR 0.36; 95% CI: 0.21-0.63]
Conclusion: None of the specific techniques that were compared reduced the two main adhesion-related clinical outcomes, small bowel obstruction and infertility. The meta-analysis provides some evidence for the surgical principle that using less invasive techniques, introducing less foreign bodies or causing less ischemia reduces the extent and severity of adhesions
ABSTRACT
Disposable items like CBC vials make an integral part of clinical laboratories. The study was carried out to determine the difference in results of four different types of vials. Study Design: It was an observational comparative study. Four hundred blood samples were included in the study. CBC was carried out within 4 hrs on all the four types of vials i.e. branded high quality and low quality vials and lab made vials with standard washing and routine washing. Instrument used was Sysmex KX - 21. All the parameters measured and compared showed no difference between four types of vials. P-value was not significant. RBC count, WBC count, Platelet count, Haemoglobin, HCT, MCV, DLC percentage in all the four types of vials showed no statistical difference in the results. The Labs can make their own CBC vials. Washing practice in haematology department KEMU is of international laboratory standards
ABSTRACT
This study was carried out to assess the haemostatic defects in patients of liver cirrhosis by estimating prothrombin time [PT], activated partial thromboplastin time [APTT], plasma fibrinogen level, fibrinogen degradation products [D-dimer], and platelet count. It was carried out at the Department of Pathology, King Edward Medical College, Lahore. A total of 50 patients from all age groups of both gender with cirrhosis of liver were selected from Mayo Hospital, Lahore. All the investigations were carried out by standard procedures. Results were analyzed statistically with appropriate tests of significance. The mean values of PT and APTT were 14 second and 19 seconds longer than the control values respectively. These prolongations were highly significant statistically [p<0.0001]. Thirty-four out of fifty patients showed a serum fibrinogen level lower than normal with the mean value of 1.90 +/- 1.30 g/L The difference from normal value was not significant statistically. All but one patient of cirrhosis, sho wed raised level of D-dimer i.e.>250 ng/ml. Mean platelet count in patients was significantly lower than normal value [p<0.05]. Prolongation of PT and APTT indicates plasma clotting factors deficiency due to impaired hepatic synthesis. Derangements of other coagulation parameters indicate that multiple factors like fibrinolysis, hypofibrinogenaemia, thrombocytopenia, and low grade DIC, all play a role in liver cirrhosis