A review of blood transfusions in a trauma unit for young children

Background. Trauma is the leading cause of mortality and morbidity worldwide. Blood transfusions play an incremental role in the acute phase, yet practice varies owing to variations in transfusion thresholds and concerns about potential complications, especially in children.Objectives. To evaluate protocol adherence to blood transfusion thresholds in paediatric trauma patients and determine the degree of blood product wastage, as defined by discarded units.Methods. A retrospective, descriptive study of trauma patients (age 0 - 13 years) who received a blood transfusion in the trauma unit at Red Cross War Memorial Children's Hospital, Cape Town, South Africa, over a 5.5-year period (1 January 2009 - 1 July 2014). Haemoglobin (Hb) transfusion thresholds were defined as 10 g/dL for neurotrauma patients and patients requiring skin grafting or a musculocutaneous flap (group 1). All other trauma patients had an Hb transfusion threshold of 7 g/dL (group 2).Results. A total of 144 patients were included (mean age 5.2 years (standard deviation (SD) 3.3), 68.1% male). The mean Hb increase after transfusion was 3.5 g/dL (SD 1.7). Adherence to the transfusion Hb threshold protocol was 96.7% for group 1 v. 34.0% for group 2. No complications were reported. Average blood wastage was 3.5 units per year during the study period.Conclusions. Adherence to paediatric blood transfusion protocol was low in the Hb threshold group <7 g/dL. However, transfusion-related complications and wastage were minimal. Further prospective research is required to determine optimal blood transfusion guidelines for paediatric trauma patients

Eradication of transfusion-induced malaria by in vitro processing

To determine the lethal dose of chloroquine to be added to donors' blood in vitro for eradication of transfusion-induced malaria and to study the unfavorable effects of this dose on the constituents of the stored blood. A total of 4484 blood donors, recruited for this study, were screened for malaria parasites microscopically using Giemsa' staining technique. Only 30 blood samples [200ml of blood each] satisfied the inclusion criteria of the study. Each of these blood samples was subdivided equally into four sub-samples to obtain 120 sub-samples. Three different concentrations of chloroquine were added to 90 specimens [30 samples represent each dose] while 30 specimens [control] were left without the drug. Blood specimens were then tested by parasitic, hematological and biochemical techniques on the day of collection and after 24 and 48 hours storage in blood bank refrigerator. The numbers of malaria parasites killed were proportional to chloroquine doses added to donors' blood. No parasites were killed among the control donors' blood samples. The determined lethal dose of chloroquine was safe to all constituents of the stored blood. For eradication of transfusion induced malaria by in vitro processing of donors blood, chloroquine is effective and safe drug. We recommend application of the optimal dose of chloroquine [626.1micro g/L] to the components of the blood bags prior to phlebotomy

Reduced bone mineral density in polytransfused patients with beta thalassemia, poorly defined role of hypoparathyroidism in pathogenesis

Patients with beta thalassemia frequently develop bone disease of multi-factorial etiology. We studied the prevalence of hypoparathyroidism in addition to other laboratory indices of bone and calcium metabolism [serum calcium, phosphorus and alkaline phosphatase], in fifty patients with beta thalassemia major and ten patients with beta thalassemia intermedia. These biochemical indices were correlated to bone mineral density assessed by dual x-ray absorptiometry [DEXA]. Hypoparathyroidism was found in 8% of the studied thalassemic patients with significantly lower serum parathormone and calcium and significantly higher serum phosphate compared to control subjects. Results of DEXA scan revealed decreased bone mineral density in 90% of the studied thalassemic patients. Serum parathyroid hormone showed no significant correlation with any of the studied DEXA parameters. In conclusion, bone disease is present in the majority of thalassemic patients with no significant correlation with parathyroid hormone, denoting that bone disease in beta thalassemia is likely to be multi-factorial

Hepatitis in dental practice - A study conducted on 1498 patients

The purpose of this study was to determine the carrier status of hepatitis Band C in those patients who were admitted in the surgical unit of Khyber College of Dentistry, Peshawar for the treatment of miscellaneous oral and maxillofacial pathologies, including fractures, cystic lesions, tumors, neurec-tomies, impactions and biopsies. All the patients were operated under general anesthesia and were screened for hepatitis B and C virus. This is the retrospective study conducted from September 2002 to December 2004. There were 1498 patients. Out of these, 44 were diagnosed as positive for the viral pathology. Some infected patients presented with a known history of jaundice, blood transfusions, major and minor dental surgeries in the past. The percentage of patients positive for HBsAg and HCVAb was 1.66 and 1.26 respectively.