Lactate and D-Dimer levels in acute pulmonary embolism and COVID-19 Lactate and D-Dimer in COVID-19

Aim: This study aimed to compare clinical data and laboratory results in patients examined for suspected pulmonary embolism (PE) in the emergency department based on three groups: patients with coronavirus disease-2019 (COVID-19), patients with PE and patients with both COVID-19 and PE. Material(s) and Method(s): This retrospective study was approved by the local ethics committee of the university. Patients included in the study were divided into three groups: Group 1, consisting of COVID-19-polymerase chain reaction (PCR) (negative) and PE (positive) patients;Group 2, consisting of COVID-19-PCR (positive) and PE (negative) patients, and Group 3, consisting of COVID-19-PCR (positive) and PE (positive) patients. Result(s): The three patient groups included in the study had no difference in terms of age (p = 0.916) or sex. The laboratory results of the groups were compared using the Kruskal-Wallis test, which showed significant differences in the levels of white blood cells (p = 0.005), lymphocytes (p < 0.001), neutrophils (p = 0.016), D-Dimer (p < 0.001) and lactate (p = 0.001). Receiver operating characteristic curve analysis with a cut-off value of >2590 for D-Dimer showed 71.43% specificity and 78% sensitivity in differentiating Group 1 from Group 2, and with a cut-off value of >3640, it had 80% specificity and 81.82% sensitivity in differentiating Group 3 from Group 2. Discussion(s): COVID-19 leads to increased incidence of PE. In addition to clinical data, D-Dimer and lactate levels can be used in the differentiation of these patients.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Quality assessment of routine produced mirasol pathogen reduction system treated platelet concentrates

Background: Prevention of transfusion-associated infections remains a challenge in transfusion medicine. The Mirasol Pathogen Reduction Technology (PRT) System uses riboflavin plus UV light to inactivate residual white blood cells and nucleic acid-containing pathogens to reduce the risk of transmission of bacteria, viruses, parasites, novel pathogens e.g SARS-CoV-2. This demonstrates the cumulative quality data of Mirasol-treated PC produced under routine conditions in our institute in the last year Methods: One hundred sixteen whole blood derived PCs, resulting from the pooling of 5 buffy coats with 250ml PAS-E solution were treated with the Mirasol technology. PCs were mixed with 35 ml Riboflavin solution and illuminated with UV-light in accordance to manufacturer's instructions. For quality control (QC) assessment the following parameters were investigated post-production (PP) and at the end of shelf-life (EOS) at days 5, 6 or 7: pH (ABL80 FLEX Blood Gas Analyzer, at 37degreeC), platelet yield (Cell- Dyn Ruby, Abbott) and CD62P-positive cells with and without TRAP-6 (100muM) using the FACS methodology with FITC-labelled CD62P antibody (Cytomics FC 500 Flow Cytometer, Beckman Coulter). Result(s): Mirasol-treated PCs showed a mean pH of 7.3 at PP and ranged 7.1 to 7.0 at EOS1. Platelet yield PP and EOS were consistent with 3.0 to 3.1 x1011 platelets (PLT)/unit. Platelet activation measured with CD62P+ expression w/o TRAP-6 was 27.7% at PP and ranged from 46.9 to 55.8 at EOS1;CD62P+ expression induced by TRAP-6 was 79.3 at PP and ranged from 72.3 to 68.1 at EOS1. Conclusion(s): The QC data on Mirasol-treated PCs produced during the past year showed encouraging results: all pH values remained far above 6.4, platelet yields remained stable suggesting min cell loss, with EOS yields always above the threshold of 2.5x1011 PLT/unit. Rates of CD62P+cells increased with time, an upregulation of CD62P+ with TRAP-6 was still detectable at EOS up to Day 7. The presented results confirm the data of the initial Mirasol validation at our site, showing the robustness of the technology. (Table Presented).

The doctor will see you now-optimising inpatient and outpatient paediatric care during the COVID-19 pandemic in a UK district general hospital

Introduction: The first wave of the COVID-19 pandemic required paediatric departments to quickly adapt to changing infection control policies, including altering physical space, pathway and rota restructuring, and adopting telemedicine platforms. As it emerged that COVID-19, as a disease entity, does not severely affect children, it became apparent the biggest challenges in delivering excellent care would be to overcome operational and organisational obstacles. Other challenges included delayed presentations of other conditions, waning staff morale and lack of paediatric specific infection control data and guidance. Methods: Our district general hospital's paediatric department established working groups comprising senior paediatricians, infection control leads and nursing managers. They regularly met during the first wave with the aim to optimise inpatient and outpatient paediatric care, agree on paediatric specific pathway changes and ensure staff morale was maintained. Actions: Paediatric doctors took over management of the paediatric emergency department (ED) to support adult services. Consultants became residents overnight to help manage ED and the requirements of a 'red' and 'yellow' admission pathway. We implemented a thrice-weekly multi-disciplinary resuscitation simulation to ensure all staff were aware of COVID adaptions to paediatric resuscitation algorithms. Weekly staff debriefs held to ensure the dissemination of pathway updates and to prioritise staff morale. Emergency funding led to the acquisition of new equipment to avoid cross-contamination with adult areas (e.g. blood gas analysers). Outpatient referrals were double-vetted by consultants and seen promptly. Over one year from January 2020, 8,104 children were seen in the clinic;4,619 (57%) were new referrals and seen face-to-face. We worked with adult services;the paediatric outpatient area was converted to an overflow adult ED. Paediatrics utilised an adult area with a larger footprint to continue face-to-face outpatient appointments. We extended our community nursing service to 7 days a week (from 5) to ensure more streamlined ambulatory care. Conclusions: Adaptability and flexibility were fundamental in implementing paediatric specific pathways. Schedule supportive team debriefs to promote staff wellbeing. Work with adult services to maintain excellent patient care throughout both specialities-we took over paediatric ED and utilised adult space to continue outpatient clinics. Anecdotally paediatricians preferred, and felt safer, undertaking face-to-face consultations for new outpatient appointments. Most children were not seen by their general practitioner prior to referral. We advocate ensuring all new outpatient referrals are seen face-to-face. Telemedicine was the preferred method for reviewing outpatient follow-ups. More research is required into the opportunities and barriers of paediatric telemedicine.