Getting patient blood management Pillar 1 right in the Asia-Pacific: a call for action

Preoperative anaemia is common in the Asia-Pacific. Iron deficiency anaemia (IDA) is a risk factor that can be addressed under patient blood management (PBM) Pillar 1, leading to reduced morbidity and mortality. We examined PBM implementation under four different healthcare systems, identified challenges and proposed several measures: (a) Test for anaemia once patients are scheduled for surgery. (b) Inform patients about risks of preoperative anaemia and benefits of treatment. (c) Treat IDA and replenish iron stores before surgery, using intravenous iron when oral treatment is ineffective, not tolerated or when rapid iron replenishment is needed; transfusion should not be the default management. (d) Harness support from multiple medical disciplines and relevant bodies to promote PBM implementation. (e) Demonstrate better outcomes and cost savings from reduced mortality and morbidity. Although PBM implementation may seem complex and daunting, it is feasible to start small. Implementing PBM Pillar 1, particularly in preoperative patients, is a sensible first step regardless of the healthcare setting.

Guillain-Barre Syndrome Presenting with Hyperreflexia – A Rare Case Report.

Guillian-Barre syndrome (GBS) is an acquired autoimmune polyradiculopathy. Areflexia and progressive flaccid weakness are essential for its diagnosis. Here we report a case of 25 year old female presenting with acute onset flaccid quadriparesis. The diagnosis of GBS was made on history and clinical findings supported by cerebro-spinal fluid (CSF) analysis and nerve conduction studies (NCS). The hallmark of this case was the presence of hyperreflexia in all four limbs without involvement of higher functions, sensory, autonomic and bulbar dysfunction. To diagnose this rare entity, a high index of suspicion is needed.

Complications of Acupuncture Treatment: Is Septic Arthritis of Lumbar Facet Joint Possible?

Acupuncture has become a popular alternative modality in the treatment of back pain. However, few have reported complications related to this treatment modality. This study reports a rare case of septic arthritis of the lumbar facet joints, developing after acupuncture, and its devastating effects upon the patient. A 68-year-old female developed septic arthritis of the lumbar facet joints after acupuncture for symptomatic control of lumbar spondylosis and stenosis while waiting for surgery. Subsequently, successful control of the infection required a total of 4 hospital admissions over a 2-year period, a CT guided spinal biopsy and 6 months of antibiotics.