ABSTRACT
Background/Case Studies: Our system has consistently purchased a higher percentage of O-negative (O-) and O-positive (O+) RBCs than other hospitals serviced by our blood supplier. Our patients' ABORh types do not mirror the US donor base. Our patients are more likely to be type O and Rh-positive due to the racially diverse population we serve. We have tried to alter the ordering practices of the transfusion services (TSs) using data sharing (DS) and monitoring. The COVID-19 pandemic created blood shortages, which severely impacted blood availability. We sought to determine whether the severe shortage of O- and O+ RBCs altered our TSs' inventory management. Study Design/Methods: Well Sky Transfusion reports for RBC transfusions from calendar years 2017 (baseline), 2019 (DS & monitoring) and 2021 (during COVID-19 with significant supply problems) were run. The ABORh of RBCs issued to patients by ABORh type were analyzed. Statistical analysis was performed using the Student's t-test. Results/Findings: The number O+ RBCs Txed to O+ patients increased significantly from 2017 (p-value 0.031) to 2019 (p-value 0.0061) and 2021 (p-value 0.0224). The number of O- RBCs Txed to O- patients increased 6.7%. Total RBC Tx increased from 17.1% from 2017 to 2021 (p-value 0.0155). Emergency issued RBCs rose 62.7% from 2017 to 2021 (p-value 0.0097). Tx of O- RBCs to non-O- patients decreased by 10.9% and total O- RBC usage decreased by 5.1%. Tx of O+ RBCs to non-O+ patients increased 32.9% while total O+ RBCs usage increased by 8.9%. Conclusion(s): Although voluntary change is possible, difficult times force behavioral changes. Shortages of type O- and type O+ RBCs forced the TSs to order more type A and type B RBCs so that they could preserve the type O RBCs for type O patients. TSs can play a role in managing blood shortage solution by trying to preferentially issued type specific RBCs when possible.
ABSTRACT
Objective: We evaluated mortality in patients with pemphigus compared with non-pemphigus individuals matched on age and gender, in the United States (US). Methods: This retrospective cohort study used data from the US Optum Clinformatics claims database between May 1, 2000 and December 31, 2020. Mortality was assessed during a follow-up of up to 4 years after the index date (first pemphigus diagnosis). A sensitivity analysis was conducted (end of study period, March 31, 2020) to exclude the potential impact of COVID-19 on mortality analysis. Multivariable models (comorbidities as adjustment variables) were used to assess hazard ratios (HRs). Propensity score matched (PSM) model was used to minimize comorbidities difference at baseline. Results: Overall, 1391 patients with pemphigus (ICD-9 and ICD-10 codes) were identified (mean [SD] age: 63.7 [17.9] years;females: 57.0%). During follow-up, 227 patients (16.3%) died in the pemphigus cohort, compared with 172 patients (12.4%) in the non-pemphigus cohort. Pemphigus patients had higher death rate than the non-pemphigus cohort (adjusted HR [95% CI]: 1.69 [1.37–2.09];unadjusted HR [95% CI]: 1.33 [1.09–1.63];PSM HR [95% CI]: 1.49 [1.19–1.86];P <.01 for all). Similar results were observed in the sensitivity analysis (adjusted HR [95% CI]: 1.77 [1.41–2.23];P <.01);PSM HR [95% CI]: 1.52 [1.20–1.93];P <.01]). Infections, hypertension, diabetes, hematologic abnormalities, and cardiovascular comorbidities were strongly associated with mortality in pemphigus patients. Conclusions: These results suggest that pemphigus is associated with increased mortality observed over 4 years, highlighting the need for better treatment options for these patients.
ABSTRACT
Background. Clostridioides difficile (C. difficile) is an important cause of morbidity and mortality. C. difficile infection (CDI) may be frequently under-diagnosed because laboratory confirmation requires collection of a stool specimen from a patient with diarrhea and appropriate laboratory testing. Methods. A prospective population-based CDI surveillance study was launched in 8 adult hospitals in Louisville, Kentucky on September 16, 2019. Surveillance officers in each hospital identified all cases of new-onset diarrhea (≥3 loose stools in the past but not preceding 24 hours) in Louisville residents ≥50 years of age. After informed consent, stool samples were collected and tested at the University of Louisville reference laboratory for 1) glutamate dehydrogenase (GDH) and 2) Clostridioides difficile toxins A and B using C. DIFF QUIK CHEK COMPLETE®, Techlab. We defined CDI as GDH positive and toxin positive. The study was paused on April 3, 2020, due to COVID-19 restrictions. Results. There were 85,719 eligible patient-days during the study period. A total of 1541 patients had new-onset diarrhea corresponding to 1.8 cases of new-onset diarrhea per 100 eligible patient-days. We enrolled 84% (1291/1541) of patients with new-onset diarrhea and tested stool samples for C. difficile from 82% (1055/1291) for a testing density of 123 per 10,000 patient-days. Of the 1055 tested stool specimens, 73 (7%) were GDH positive and toxin positive (Figure 1) yielding a hospital-based CDI incidence of 8.5 CDI cases per 10,000 patient-days. Conclusion. New-onset diarrhea was common among hospitalized adults ≥50 years of age. CDI was frequently identified through stool specimens collected from eligible inpatients with new-onset diarrhea. Further analysis of these data and additional laboratory testing will contribute to a better understanding of the frequency of CDI underdiagnosis and the burden of CDI in the United States.
ABSTRACT
Cytomegalovirus (CMV) is a DNA hepadnavirus, commonly implicated in reactivation disease after immunosuppression, especially in solid-organ and stem cell transplant patients. Bendamustine is an alkylating chemotherapeutic agent introduced into the management of hematological malignancies within the last decade. Few reports have raised potential concern for CMV reactivation disease after bendamustine therapy involving, but not limited to, the gastrointestinal tract, lungs, retina, and viremia. Cytomegalovirus reactivation in such instances should be added to the differential diagnoses for febrile nonneutropenic immunocompromised patients. Here, we report a case of an elderly gentleman recently diagnosed with mantle cell lymphoma who was started on chemotherapy with rituximab, bendamustine, and dexamethasone and developed CMV colitis and viremia after just 2 cycles of chemotherapy.
ABSTRACT
Background/Case Studies: The COVID-19 (C-19) pandemic has altered almost everything. The first case of C- 19 was confirmed in New York (NY) on 3/1/20. As of 6/30, there were >212,000 confirmed cases, >50,000 patients hospitalized, and >18000 confirmed and >4600 probable deaths in NYC. Quarantines diminished the blood supply, and all elective surgery was canceled effective 3/16. We sought to assess the transfusion needs of hospitalized C-19 patients in our system. Study Design/Methods: After obtaining IRB approval, an EMR report to identify all patients, who had a positive SARS-CoV-2 PCR test result and were transfused between 3/1/20 and 6/30/20, was created to identify howmany C-19 patients had been transfused and the number and type of blood products they received. Results/Findings: From 3/1-6/30, 12973 confirmed patients had been admitted to the hospital and transfused a total of 4297 blood products. Of the admitted confirmed patients, 1024 patients were transfused at least one blood product. A MTP was activated on 12 patients, and 9 were placed on ECMO. 3644 RBCs, 267 SDPs, 339 plasmas, and 47 pooled CRYO were transfused to C-19 patients. Table 1 depicts the mean number, range, and percent of transfusions by product type administered. Table 2 shows the data for patients who required intubation. Patients who died in the hospital were more likely to be transfused than those who had a routine discharge (13.1% vs 9.2%). 39 patients who required intubation and died in the hospital received a RBC transfusion. Conclusions: 1024 COVID-19 patients were transfused a total of 4297 blood products. 22.7% of all blood products during the period were transfused to C-19 patients. C-19 patients received 26.9% of RBCs, 9.1% of plasmas, 20.8% of SDPs, and 15.4% of pooled CRYO transfused in the hospital. An ample blood inventory is required to support the care of C-19 patients especially those requiring ECMO and intubation.