Blood transfusion practice in critically ill patients: a single institutional experience

To assess the transfusion practice in the intensive care unit [ICU] in a general hospital in Kuwait relative to indications, pretransfusion hemoglobin, red blood cell [RBC] use and outcome. 475 patients were admitted to the ICU during the study period [January 2009 to February 2010]. Ninety-nine received RBC transfusion. Demographic, clinical and transfusion data were prospectively collected for the 99 patients who were followed up for 30 days, until hospital discharge, or death, whichever occurred first. Indications for RBC transfusion included hemorrhage in 39 patients, improving oxygen-carrying capacity in 55, and hemolysis in 5. Of the 99 transfused patients, 22 [22.22%] were also transfused after discharge from the ICU. Transfusions were more frequent in patients admitted with respiratory failure [30, 30.3%], hemorrhagic shock [24, 24.2%], and septic shock [18, 18.4%]. The mean pretransfusion hemoglobin in ICU transfusions was statistically different [70.9 +/- 12.7 g/l] from transfusions after discharge [79.7 +/- 9.4 g/l] [p < 0.001]. Longer ICU stay was associated with more RBC units transfused per transfusion episode per patient [p < 0.001]. The Sequential Organ Failure Assessment [SOFA] score was significantly associated with the number of RBC units transfused per patient [p = 0.006]. Mortality was significantly associated with Acute Physiology and Chronic Health Evaluation II and SOFA scores, the need and duration for mechanical ventilation, and the length of stay in hospital. Intensivists in our center followed a restrictive transfusion practice, by adopting a low pretransfusion hemoglobin threshold. Decisions on RBC transfusions seemed in most cases to be based on a 'transfusion trigger' rather than a physiologic need

Determinants and associations of homocysteine and prothrombotic risk factors in Kuwaiti patients with cerebrovascular accident

The objective ofthis study was to evaluate the determinants and associations of some prothrombotic risk factors in patients with cerebrovascular accidents [CVAs]. In this case-control study, plasma total homocysteine [tHcy], lupus anticoagulant, protein C, protein S, activated protein C resistance [APC-R] and antithrombin were measured in 102 patients [60 males and 42 females] and 167 controls [87 males, 80 females]. Serum vitamin B[12], folate, red cell folate, creatinine, lipid profile and glucose were also determined. Glomerular filtration rate [GFR] was calculated.13 [22%] of the 60 male patients, and 16 [39%] of the 42 female patients had hyperhomocysteinemia. Median [interquartile range] tHcy was higher in male patients [11.22 Mu mol/l [9.60-15.40]] than female patients [10.05 Mu mol/l [8.72-17.54]]. On binary logistic regression analysis, the significant [p < 0.05] determinants of tHcy were urea, creatinine and GFR. Comparing patients with control subjects showed that tHcy, age, fasting glucose, urea, serum creatinine, white blood cell count, protein S, APC-R and factor VIII were significantly higher, while protein C, factor II, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol were significantly lower in patients. Lupus anticoagulant was not associated with tHcy and not detected in patients and controls. Low concentrations of vitamins B[12] and folate were not associated with tHcy. Logistic regression analysis showed a significant association of tHcy with CVA [OR = 9.55; p = 0.047] in males in the presence of other traditional CVA risk factors but tHcy is not independently associated with CVA in females. Hyperhomocysteinemia is common in Kuwaiti patients with CVA and tHcy probably interacts with prothrombotic factors [protein C, APC-R and factor VIII] to increase CVA risk. The main determinants, age and GFR markers, should be kept in mind when determining the risk associated with tHcy

Hodgkin's disease: Kuwait experience

To describe histologic subtypes, clinical presentation and treatment outcome of Hodgkin's lymphoma in Kuwait. Subjects and Method: Patients older than 15 years, diagnosed with Hodgkin's lymphoma between 1980 and 1998, were included in this retrospective analysis. Data were collected using a standardized form that included demographics, histologic subtypes, clinical presentation, stage, extranodal involvement, treatment modality and follow-up. Histology reports were obtained from hospital records. There were 83 [59%] males and 57 [41%] females. Dominant histologic subtypes were nodular sclerosis 65 [46.4%] and mixed cellularity 42 [30%]. Constitutional symptoms were reported by 54 [38.6%] of the cases. Two thirds [64%] of the cases were advanced. Primary extranodular involvement included liver [8%], gastrointestinal tract [7%], lung and bone marrow [4% each]. Disease-free survival according to treatment groups were: radiotherapy alone 100%, chemotherapy alone 88%, and combined modality 65%. The 5-year Kaplan-Meier estimates of overall disease-free survival was 84%. In the cohort of 137 patients with Hodgkin's disease the treatment with combined radiotherapy and chemotherapy had a remarkable outcome. However, evaluation of long-term treatment complications is needed