ABSTRACT
Objectives: Varicella is common infectious disease mainly in childhood, usually is a mild, self-limited illness and complications are usually rare. The incubation period for this disease is generally 14- 16 days but may vary from 7 to 21 days. Varicella in the adults with comorbidities or immunosuppressed children may be severe and prolonged with complications. Method(s): A case report of a 6-year-old girl hospitalized for new-onset manifestations of disseminated vesicular exanthema, the manifestations of which occurred mainly on the chest, back, capillitium, oral cavity, and genital area. The child was suffering from abdominal, knee and lumbosacral pain at that time. The patient's history revealed that 10 days prior to the cutaneous manifestations, she had influenza with bronchopneumonia requiring oxygen therapy, steroids and antibiotics. Result(s): The condition progressed within 48 h, complicated by the development of multi-organ failure, coagulopathy with the development of disseminated intravascular coagulopathy over the course of antiviral, antibiotic and antifungal therapy. Laboratory parameters included high elevation of C-reactive protein, il-6, leukocytosis, neutrophilia and highly elevated liver enzymes. Varicella infection was confirmed by detection of herpes zoster virus - polymerase chain reaction (PCR) from vesicles. The patient received intravenous immunoglobulin therapy at a dose of 2 g/L and fresh frozen plasma, thrombocyte concentrate. The girl was intubated with analogization. Laboratory parameters subsequently revealed high anti CoV-2 positivity, high CoV-2 IgG positivity and negative CoV-2 IgM. The patient's condition did not preclude the course of multisystem inflammatory syndrome in children (MIS-C) corticosteroids were added to the treatment at a dose of 1 mg/kg weight. Patient's condition stabilized after 1 month. Discussion(s): Our case report presents an example of fulminant complicated life-threatening course of varicella. Even in common respiratory infections, we must think about the risk and consequences of coinfections and post-infectious complications such as in our case especially influenza and COVID-19.
ABSTRACT
Introduction: Due to the COVID-19 outbreak, many chronic patients and elective surgical procedures have been postponed to create spaces for the hospitalization of COVID-19 patients, raising issues related to this change. The objective of this study is to assess the effect of the COVID-19 pandemic on the demand for blood products transfusion. Materials ant methods: The study presents the results of a retrospective study of blood transfusions in COVID-19 patients admitted to the Constanta County Emergency Clinical Hospital. The period of study was January-December 2021. We compared the transfusion requirement for each type of blood component in COVID 19 patients versus patients with non-COVID pathology. Results and discussions: During 2021, we transfused 282 COVID-19 patients;150 patients had only Covid pneumonia (of which 19 patients with severe forms needed intensive care in ICU-Covid), and 132 patients had various co-morbidities. The maximum blood requests was registered in the period February - April 2021, with a peak of 63 patients in April 2021. The main co-morbidities in patients with Covid 19 were: severe anemia in patients with malignant hemopathies. Anemia at admission in patients with Covid pneumonia is reported in more than 40% of patients. Moderate anemia (Hb <11 g/dL) is considered as an independent risk factor for the severe course of COVID-19 infection and mortality in these patients. The transfusion requirement in these patients was greater than 1.43 RBC (units/patient), 0.81 Plasma units/patient, 0.40 Platelets concentrate units + single donor platelet concentrate units/patient, in accordance with the associated pathology. Conclusion(s): The most requested product was packed red blood cells, the correction of anaemia being an important factor in preventing the severe course of the disease. The platelet requirement was 0.15 units/patient, thrombocytopenia being present in patients with severe evolution of the infection (hospitalized in ICU-COVID). The most requested blood groups were O+ and A+. COVID-19 transfusion data will help plan and prepare for the use of blood resources during the pandemic.Copyright © 2022 Sevigean Ali et al., published by Sciendo.
ABSTRACT
Hepatitis A is a common viral infection worldwide that is transmitted via the fecal-oral route. Since the introduction of an efficient vaccine, the incidence of infection has decreased but the number of cases has risen due to widespread community outbreaks among unimmunized individuals. Classic symptoms include fever, malaise, dark urine, and jaundice, and are more common in older children and adults. People are often most infectious 14 days prior to and 7 days following the onset of jaundice. We will discuss the case of a young male patient, diagnosed with acute hepatitis A, leading to fulminant hepatitis refractory to conventional therapy and the development of subsequent kidney injury. The medical treatment through the course of hospitalization was challenging and included the use of L-ornithine-L-aspartate and prolonged intermittent hemodialysis, leading to a remarkable outcome. Hepatitis A is usually self-limited and vaccine-preventable;supportive care is often sufficient for treatment, and chronic infection or chronic liver disease rarely develops. However, fulminant hepatitis, although rare, can be very challenging to manage as in the case of our patient.Copyright © 2023 The Author(s).
ABSTRACT
A 5-month-old, intact male, yellow Labrador retriever was presented with a 24-hour history of anorexia and vomiting. Abdominal imaging revealed the presence of a mechanical obstruction in the jejunum and peritoneal effusion. Cytologic evaluation and culture of the effusion prior to surgery identified a suppurative exudate with bacteria consistent with septic peritonitis and suspected to be related to the intestinal lesion. An exploratory laparotomy was performed, and a segment of jejunum was circumferentially severely constricted by an off-white, fibrous band of tissue. Resection and anastomosis of the strangulated segment of jejunum and excision of the constricting band provided resolution of the clinical signs. The dog made a complete recovery. Histologic evaluation revealed the band to be composed of fibrovascular and smooth muscle tissue, consistent with an idiopathic anomalous congenital band. No other gastrointestinal lesions were observed, either grossly at surgery or histologically in the resected segment of intestine. To our knowledge, a similar structure has not been reported in the veterinary literature.Copyright © 2022 Canadian Veterinary Medical Association. All rights reserved.
ABSTRACT
Objective: Non-puerperal uterine inversion is a rare occurrence. The common etiology for this condition is uterine sarcoma, endometrial carcinoma, and myoma. Case Presentation: This case is a 44-year-old woman with a protruding malodorous vaginal mass, abdominal pain, and urinary retention. Total hysterectomy with bilateral salpingectomy was per-formed. Conclusion: Diagnosis of uterine inversion might be difficult and requires a high index of suspicion. © 2023 Bentham Science Publishers.
ABSTRACT
Case Report: Atypical Hemolytic Uremic Syndrome (atypical HUS) is a rare and severe form of thrombotic microangiopathy (TMA) characterized by thrombocytopenia, intravascular hemolysis, and acute kidney injury with an incidence of 1 per million.1 Dysregulation and overactivation of the complement alternative pathway due to genetic mutations have been detected in 40-60% of patients with sporadic or familial atypical HUS.2,4 Triggers include viral illness, pregnancy, malignancy, sepsis, or sporadically with no known inciting event.1 Atypical HUS is a severe disease with a 2-10% risk of mortality, 33% risk of end-stage renal failure, and 50% chance of relapse.5 A 24-year-old female with prior history of atypical HUS at the age of 16 (with response to plasmapheresis) presented to the ER with a 5-day history of fever, chills, sore throat, nausea, vomiting, and dark urine. She tested positive for COVID-19. The exam revealed scleral icterus and scattered petechiae. Labs demonstrated nadir hemoglobin (Hgb) of 9.2 g/dL, platelet count of 52 000k/uL, haptoglobin < 30 mg/dL, peak LDH 1128U/L and creatinine 4.62 mg/dL. Urinalysis is consistent with hemoglobinuria. Schistocytes were noted on the peripheral smear. Rapid streptococcal antigen test and C3, C4, and IgA levels were unremarkable. Chest X-Ray, X-ray KUB, and ultrasound abdomen were unremarkable. The pregnancy test was negative. ADAMTS13 was >100%. Genetic analysis after the initial episode at age 16 revealed autosomal recessive inheritance c.193A > c gene mutations in C3. The patient received IV fluids, ceftriaxone for cystitis, and two units of Fresh Frozen Plasma. She initiated treatment with eculizumab. She also received the MENVEO and meningitis B vaccine per protocol due to the risk of meningitis from terminal complement deficiencies. After 4 infusions of eculizumab, patient's labs improved to platelet count of 307 000 k/uL, Hgb 12.2 g/ dL (nadir 9.2 g/dL), haptoglobin 78 mg/dL normalization of LDH and improved creatinine. Atypical HUS is a rare form of TMAwith mutations in C3 noted in 5% of cases. Complement cascade dysfunction leads to endothelial deposits and microvasculature damage. The resulting prothrombotic state causes obstructive microvascular thrombi predominantly affecting the kidneys but can cause multiorgan dysfunction. The SARS-CoV-2 virus may precipitate atypical HUS relapse due to endothelial damage and complement activation further intensified in patients with existing complement aberrations. Plasma exchange remains a standard of care for atypical HUS, as it effectively removes the antibodies and other proteins. Eculizumab a humanized monoclonal IgG antibody binds to complement proteins, preventing cleavage into C5a and C5b blocking C5b-9(MAC) activation. In patients with CFH, CFI, C3, and CFB mutations, eculizumab is the preferred intervention. Copyright © 2023 Southern Society for Clinical Investigation.
ABSTRACT
Rationale: The impact of COVID-19 in patients with autoimmune liver disease treated with immunosuppressive therapy has not been described so far. This case report describes the clinical course of a patient with autoimmune hepatitis (AIH) who developed COVID-19 and the features of cytokine syndrome leading to its deterioration in our intensive care unit. Patient's Concern: A 28-year-old male presented with generalized anasarca for two weeks and chronic liver disease for 8 months. Diagnosis: AIH and Covid-19 with features of cytokine storm syndrome. Interventions: Intravenous furosemide, mannitol, syrup lactulose, steroids (prednisolone 40 mg), azathioprine 1 mg/kg body weight, rifaximin, vitamin K, and blood products. Outcomes: The patient had hepatic encephalopathy and AIH and died on the 10th day after admission despite ventilatory support, sustained low-efficiency hemodialysis, and resuscition. Lessons: The dramatic release of cytokines and the inflammatory-immune responses not only alter the pathophysiology but also affects the onset and severity of disease progression in patients with AIH.
ABSTRACT
The glycocalyx attached to the apical surface of vascular endothelial cells is a rich network of proteoglycans, glycosaminoglycans, and glycoproteins with instrumental roles in vascular homeostasis. Given their molecular complexity and ability to interact with the intra- and extracellular environment, heparan sulfate proteoglycans uniquely contribute to the glycocalyx's role in regulating endothelial permeability, mechanosignaling, and ligand recognition by cognate cell surface receptors. Much attention has recently been devoted to the enzymatic shedding of heparan sulfate proteoglycans from the endothelial glycocalyx and its impact on vascular function. However, other molecular modifications to heparan sulfate proteoglycans are possible and may have equal or complementary clinical significance. In this narrative review, we focus on putative mechanisms driving non-proteolytic changes in heparan sulfate proteoglycan expression and alterations in the sulfation of heparan sulfate side chains within the endothelial glycocalyx. We then discuss how these specific changes to the endothelial glycocalyx impact endothelial cell function and highlight therapeutic strategies to target or potentially reverse these pathologic changes.
ABSTRACT
Background: There is universal concern about the inappropriate use of fresh frozen plasma (FFP). Earlier investigations have indicated that FFP may be associated with high rates of inappropriate transfusion, with some studies indicating rates of up to 50% non-compliance with established guidelines. The current British Committee for Standards in Haematology (BCSH) guidelines on the use of FFP aim to reinforce the message regarding avoidance of its inappropriate use. Aims: Audit the use of appropiate FFP in the context of the COVID pandemia. Methods: Retrospective analysis of requests for plasma transfusion in adults, in our institution, between January/2020 and January/2022, This audit was undertaken to determine current use of FFP and to see if any improvements in the use of this component in relation to recommended guidance. May be we use more FFP due to covid situation. The data was obtained by consulting the Integrated System of Blood Banks. Results: During the study period, 98 units of FFP were used for 'acute' episodes including management of acute COVID complications. Only 67% of these transfusion episodes were deemed appropriate, based on the BSH criteria. This also means that 13 units of FFP may have been wasted. FFP is used by both medical and surgical specialties with general surgery, general medicine and neurosurgery being the main users. During the study period, 98 units of FFP were used for 'acute' episodes including management of acute COVID complications. Only 67% of these transfusion episodes were deemed appropriate, based on the BSH criteria. This also means that 13 units of FFP may have been wasted. FFP is used by both medical and surgical specialties with general surgery, general medicine and neurosurgery being the main users. 159 requests for plasma were registered in the analyzed period. In most cases (98), the reason was hemorrhage due to multiple factor deficiencies, including liver disease, trauma, lung disease or a massive transfusion. Prophylactic/therapeutic replacement of congenital factor XI deficiency, associated with bleeding episodes, was indicated in 2 situations. In 1 case, the indication was treatment of HUS and 2 cases of HELLP syndrome. In 7 cases, there was an overlapping of indications. In 7 cases, plasma was administered in unforeseen situations, such as for the correction of laboratory abnormalities without clinical manifestations (4 cases) or for prophylaxis of invasive techniques without abnormal coagulation tests (2 cases). Summary/Conclusion: The proportion of inappropriate requests is similar between surgical and non-surgical specialties and also when broken down into individual departments, the number of inappropriate requests consistently outnumbers appropriate requests across all departments. FFP continues to be frequently used in the absence of bleeding and / or evidence of abnormal coagulation, thus highlights the need for concerted efforts in the education of clinicians who prescribe FFP. In the analysis of the indications for plasma prescription, it is concluded that in 17 % cases the indication was not complete adequately or justifable. 7% of cases given FFP had no record of post-transfusion coagulation data. Following this work, dissemination coupled with education was undertaken. The use of FFP for Warfarin reversal has correctly indicated (> 95%). it may suggest that an education programmes directed at specific aspects of practice do influence clinical behaviour over needs to be addressed.
ABSTRACT
INTRODUCTION. The significance of all components of donor plasma on the process of inflammation in patients with COVID-19 is currently a little-studied problem. The OBJECTIVE was to determine the effect of components of donor plasma on the inflammatory process in COVID-19. METHODS AND MATERIALS. The study included 50 patients with coronavirus infection (COVID-19), bilateral poly-segmental pneumonia, who received standard therapy. Anticovid plasma transfusions were performed in 38 patients. Quarantine fresh frozen plasma was transfused to 12 patients. Before and after transfusion, changes in biochemical, immune, clinical and instrumental parameters of patients were evaluated in dynamics. Separately, the intensity of humoral immunity to SARS-CoV-2 was evaluated in donors of anticovid plasma and in all patients in dynamics. The dynamics of changes in the parameters of components of donor plasma was studied with an assessment of their correlation relationships between biochemical and immune blood parameters before and after transfusion. The most significant component of donor plasma affecting the inflammatory process in COVID-19 was identified. RESULTS. After transfusion of any type of donor plasma, the parameter of the intensity of humoral immunity to SARS-CoV-2 increased with normalization of clinical and instrumental parameters and a decrease in the parameters of acute phase inflammatory reactants. The value of the alpha2-macroglobulin index was reduced, and it increased after transfusion. Correlations between acute phase inflammatory reactants and donor plasma components before and after transfusion with any type of donor plasma were consistently studied. As a result, the interrelations of varying degrees of severity with the alpha2-macroglobulin index were revealed. CONCLUSION. After transfusion of any type of donor plasma, there is an increase in the intensity of humoral immunity to SARS-CoV-2 in the form of the appearance of specific antibodies, the parameters of acute phase inflammatory reactants decrease. One of the significant components of donor plasma affecting the inflammatory process in COVID-19 is alpha2-macroglobulin. The study of the possibility of using alpha2-macroglobulin isolated from donor plasma is one of the promising directions in the complex treatment of COVID-19 patients. © 2022 Consilium Medikum. All rights reserved.
ABSTRACT
Introduction: Abnormally invasive placenta (AIP) has a significant risk of mortality and morbidity. International recommendations support management in specialist centres [1]. North Bristol Trust (NBT) is a large obstetric unit providing regional management since 2014 this service evaluation shows changing management over an eight year period, in line with local experience and published recommendations. Methods: Retrospective database analysis (with local audit approval) of AIP cases at NBT 2014–2021 were performed. Antenatal and perioperative management was reviewed via electronic patient records. Results: Sixty-one patients presented with AIP. Mean maternal age was 35.2 years and mean gestation at delivery was 34 + 2 weeks. Average paritywas 2.5 (range 0–7). No maternal deathswere recorded. Sixty women were identified pre-operatively and one unexpected intraoperatively. Postoperatively 60 cases were managed on our level- 2 obstetric critical care unit, one required level-3 critical care. Anaesthetic technique has evolved including: general anaesthetic (GA) plus low-dose spinal 36%;GA alone 36%;combined spinalepidural (CSE) 23%;CSE converted to GA 3%;epidurals 1.5%;and spinals 1.5%. Forty-five cases (72%) delivered via elective CS and 28% required urgent CS. Invasive arterial blood pressure monitoring was used in 84%. The hysterectomy rate was 67% (59% elective vs 100% urgent cases). Of 16 cases in the hybrid theatre, only four internal iliac artery balloons (IAB) were inflated (25%), for a mean of 62 min. One complication occurred, a femoral artery thrombus requiring embolectomy at the end of case. Mean estimated blood loss for all cases was 3.5 L (range 0.5–14 L). No statistical differencewas noted in blood loss with or without IAB (3.6 vs 3.1 L), nor planned vs urgent surgery. Intraoperative cell salvagewas used 97%;mean volume of cell salvaged blood (CSB) reinfused was 0.7 L (range 0–3.3 L). Packed red blood cells were transfused in 44%, fresh frozen plasma in 34%, platelets in 18%, and cryoprecipitate in 44%. ROTEM was utilised in 56% of cases and TXA given in 82%. Discussion: IAB have not been used in AIP management for 2 years in our institution. This does not appear to affect blood loss, transfusion rate, or requirement for critical care. Our GA rate has remained high compared to other centres [2], due to hybrid theatre ergonomics and Covid-19 PPE requirements. Use of autologous blood transfusion via cell salvage with rapid processing is central to our care.
ABSTRACT
In sepsis, both beneficial and detrimental effects of fresh frozen plasma (FFP) transfusion have been reported. The aim of this study was to analyze the indication for and effect of FFP transfusion in patients with septic shock. We performed a secondary analysis of a retrospective single-center cohort of all patients treated for septic shock at the interdisciplinary surgical intensive care unit (ICU) of the Heidelberg University Hospital. Septic shock was defined according to sepsis-3 criteria. To assess the effects of FFP administration in the early phase of septic shock, we compared patients with and without FFP transfusion during the first 48 h of septic shock. Patients who died during the first 48 h of septic shock were excluded from the analysis. Primary endpoints were 30- and 90-day mortality. A total of 261 patients were identified, of which 100 (38.3%) received FFP transfusion within the first 48 h after septic shock onset. The unmatched analysis showed a trend toward higher 30- and 90-d mortality in the FFP group (30 d: +7% p = 0.261; 90 d: +11.9% p = 0.061). In the propensity-matched analysis, 30- and 90-day mortality were similar between groups. Plasma administration did not influence fluid or vasopressor need, lactate levels, ICU stay, or days on a ventilator. We found no significant harm or associated benefit of FFP use in the early phase of septic shock. Finally, plasma should only be used in patients with a strong indication according to current recommendations, as a conclusive evaluation of the risk-benefit ratio for plasma transfusion in septic shock cannot be made based on the current data.
ABSTRACT
Background: It's more than 2 years since the strike of a COVID-19 pandemic caused by severe acute respiratory syndrome Coronavirus 2. It had infected nearly 400 million populations globally and affected several important sectors worldwide such as the economy, social and healthcare services. To date, Malaysia recorded more than 3 million confirmed cases of COVID-19. The first nationwide Movement Control Order (MCO) started on 18th March 2020 then followed by multiple series of targeted MCOs on several states with a high surge up of cases. The National Blood Center (NBC) and State Blood Transfusion Services (SBTS) experienced significant reduction of blood collection, the shortage of blood availability and supply. The total blood collection in the year 2020 was 655,069 units, showing a 12% reduction compared with the year 2019. Blood supply management requires an integrated and holistic planning from all stakeholders to ensure the judicious use of blood and blood components in the normal situations, pandemics, crises, or during blood shortages. Aims: This study was to determine the characteristic of blood components mobilized during the COVID-19 Pandemic and to assess the coordination of inter-regional blood availability, supply, and transportation between the blood inventory of NBC, SBTS, or Hospital Blood Bank. Methods: A retrospective study was conducted from 18th March 2020 until 18th August 2021 where multiple series of MCOs were instated. Data from the blood inventory during the 18 months were analysed. All data were retrieved from Blood Bank Information System from NBC and SBTS. Results: A total of 17,144 units of blood components have been mobilized and distributed, comprised of 15,591 units of red cell, 1107 units of platelet concentrates, 299 units of Fresh Frozen Plasma, 125 units of Cryoprecipitate and 22 units of Convalescent Plasma. Overall, there were 20 blood collection centers comprised of NBC, state hospitals, and major hospitals involve as blood providers to the (Table Presented) several affected blood collection centers, beyond the state border. The states with major contributions for blood component mobilization were Kuala Lumpur, Sarawak and Johor while the collection centres that provided the most blood were National Blood Centre (4542 bags), Sultanah Aminah Hospital in Johor (1714 bags) and Malacca Hospital (1630 bags). The blood products have been shipped via hospitals' land transportation, air transportation by courier service and collaborative mercy flight by the Malaysian Air Force to the Malaysia East. The validated blood packaging and transportation procedure have been implemented to preserve the blood cold chain during blood mobilization through the air or by land transportation. Summary/Conclusions: The challenges during a pandemic are to deliver adequate, safe, and quality blood to the patient who needs blood transfusion for life-saving. Dynamic inter-state blood availability, supply and mobilization are essential to overcome the shortfall during a pandemic. Effective communication among NBC, SBTS, interagencies, governmental organizations, and postal service companies were among the great factors of success in transporting blood beyond borders to ensure blood availability. The plan was designed in response to the threat to the national blood supply from any untoward events that lead to blood shortages in a state, regional, or nationwide in Malaysia.
ABSTRACT
Background: The first wave of COVID-19 outbreak in Malaysia started with the first case in January 2020 followed by the second wave in February 2020 and the third wave in October 2020. In the early phase, COVID-19 patients were treated in designated Ministry of Health (MOH) hospitals only. However towards the end of 2020, as the crises set in, COVID-19 patients were also being treated in private centres and university hospitals including our centre, Universiti Teknologi MARA (UiTM) Medical Specialist Centre. Aims: To evaluate the utilization of blood components among hospitalized COVID-19 patients. Methods: Retrospective study of blood component transfusions among hospitalized COVID-19 patients from January 2021 to December 2021 was conducted in Transfusion Medicine Unit, UiTM Medical Specialist Centre. The data was retrieved from Blood Bank Information System (BBIS) and transfusion request forms. The type of blood products and the number of blood components transfused to the patients were analysed. Results: Overall, 256 COVID-19 patients were admitted to our centre in 2021. Twenty-eight of the patients received blood product transfusions for an overall transfusion rate of 10.9%. Out of a total of 2438 blood components used by all patients admitted to our centre in 2021, 4.3% of blood components were transfused to COVID-19 patients in which the majority were red blood cells, 56 units (4.2%) followed by platelets 40 units (9.5%) and fresh frozen plasma 9 units (1.8%). Summary/Conclusions: The transfusion rate of blood components among hospitalized COVID-19 patients is lower than other hospitalized non-COVID-19 patients.
ABSTRACT
Background: Over the years, transfusion therapy has profited healthcare in improving health outcomes of a wide spectrum of patients. However, the stability and availability of adequate blood supply is not always ensured. Disasters such as the COVID-19 pandemic may pose significant threats to blood supply management- which may also affect the performance of healthcare systems. Recent studies and news have highlighted the effect of the COVID- 19 crisis to blood supply management but not much has been studied on the trends in blood supply management in a Philippine setting which may provide information on how blood supply is being managed locally in the presence of challenges amid the COVID-19 pandemic. Aims: The current study aimed to explore the trends in blood collection, utilization and wastage in Region III, Philippines in the years 2019 and 2020 to describe the impact of the pandemic on local blood supply management. Methods: Secondary data from the Department of Health-Central Luzon, Philippines was used to calculate the proportion of decrease or increase in blood donation, usage, and wastage during the pandemic. Results: During the course of the pandemic, five out of the six provinces included in the study had decreased voluntary blood donations (-31.87%) while four out of six had increased replacement donations (28.82%), which reduced the total blood donation output in the region (-14.46%). In addition, a lower utilization of whole blood (-21.53%) and platelet concentrate units (-19.70%) caused an overall decrease in blood usage (-5.29%). Lastly, a high wastage of fresh frozen plasma units (52.35%) largely contributed to the general increase in unused blood products (10.91%). Summary/Conclusions: A shift in the sources of blood donations (i.e., increased replacement donations) was observed in Region III, Philippines during the COVID-19 pandemic. This can be attributed to the implementation of social restrictions that prevented mass blood donations and rendered replacement donations as the 'safer' option in preventing the spread of COVID-19. Moreover, the demand for blood utilization decreased during the pandemic which relates to the efforts of blood supply managers to balance the demand and supply of blood products since the pandemic reduced the blood donation output in the region. However, this attempt to decrease blood demand resulted in an increased wastage of blood products. The findings of this study calls for the establishment of preparedness plans to efficiently combat against disasters such as the COVID-19 pandemic.
ABSTRACT
Background: Blood transfusion services are of paramount importance in cancer care. Streamlined and judicious usage of this scarce resource against the higher demand is one of the greatest challenges. Continuous monitoring of the utilization pattern of the blood components paves the way for better picturization of the transfusion practices and formulating strategies for implementation of better patient blood management. National blood policy of India encourages appropriate clinical use of blood components. An oncology care facility poses an additional challenge of random variation in demands against a low supply. This warrants a more stringent monitoring of the blood component utilization pattern according to the patient profiles, indications for transfusions and onward therapeutic benefits. Aims: Evaluation of pattern of blood component utilization in a blood storage center catering to oncology only. Methods: This retrospective study was conducted in a blood storage center of an oncology-only center. Time frame of the study was June 2019 through August 2021. The procurement of components from the mother blood center, onward issue details to different wards for transfusion of all blood components [Packed red blood cells units (PRBC), Fresh frozen plasma units (FFP), Platelet units (PLT)], and discard of components with reference to their respective causes were recorded. Effects of COVID-19 pandemic on the utilization pattern was also recorded to assess the variations in the utilization pattern. The statistical analysis was done by using Microsoft Excel (Office 365 version, Microsoft, USA). Results: A total of 4599 component units were procured which is comprised of 2196 (47.75%) PRBC, 2012 (43.75%) PLTs and 391 (8.5%) FFPs. A total of 3624 of 4599 units (78.8%) were requested during the study period which is comprised of 2076 of 2196 PRBCs (94.5% utilization), 1189 of 2012 PLTs (59.1% utilization) and 359 of 391 FFPs (91.8% utilization). A total of 652 of 4599 units were received back which is comprised of 76 of 2196 PRBCs (3.5%), 565 of 2012 PLTs (28.1%) and 11 of 391 FFPs (2.8%). Majority of the blood components 1553 of 3624 (42.85%) were issued to patients admitted under medical oncology comprised of 924 of 2076 (44.5%) PRBCs, 533 of 1189 (44.8%) PLTs and 96 of 359 (26.75%) FFPs followed by to onco-emergency and patients admitted under surgical oncology. COVID surge led to curtailment of oncology care as the facility catered to the COVID patients with 310 PRBCs (14.9%), 408 RDPs (34.31%) and 102 FFPs (28.4%). A total of 271 units (5.9%) were discarded during this time which is comprised of only 4 of 2196 PRBCs (0.18%) due to failure in cold chain maintenance, 254 of 2012 PLTs (12.6%) and 13 of 391 FFPs (3.32%) due to breakage of units or receive back from wards beyond 30 min. Summary/Conclusions: Blood utilization patterns change with the patient profiles, level of organization in an oncology center. This storage center data presented here is a preliminary step for planning and maintaining a balance between demand, supply, and wastage. Although the utilization rate of PRBCs and FFPs were >90%, the same for the PLTs was <60%. This is attributed to planning errors and unpredictable demand to supply. The proportions of wastage were <5% for PRBCs and FFPs but was >12% for RDPs due to logistic issues, expirations, and non-compliance to good clinical practices. A comprehensive approach by a multi-disciplinary team will help streamline the judicious usage of the blood components at our center.
ABSTRACT
Background: Acute Transverse Myelitis (ATM) is a very uncommon neurological syndrome, characterized by acute or subacute spinal cord dysfunction that can lead to paresthesias, sensory/autonomic impairment and paralysis. The aetiology is often unclear, but infectious, para-infectious, systemic autoimmune diseases, paraneoplastic, ischemic diseases and drugs are potential causes. Vaccine administration can also trigger an immune response and induce an autoimmune response;however, ATM has rarely been reported as a complication of COVID-19 infections or vaccination. The treatment mainly consists of steroids and plasmapheresis, which often reverses any neurologic symptoms. The therapeutic plasmapheresis is a highly complex procedure. It separates the patient's blood components replacing the plasma removed by solution that can be fresh frozen plasma or albumin, allowing the removal of the autoantibody, immune complex, lipoprotein or endotoxin that's causing the pathology. Aims: Clinical case report. Methods: A 46-year-old male patient, with personal history of hypertension and obesity, 3 weeks after COVID-19 vaccination, presented to the emergency department due to urinary complaints (urgency and pollakiuria), progressive numbness, paresthesias and decreased muscle strength in the lower limbs and decreased sensibility in the perineal region. Physical examination revealed total gait disability, decreased sensation and strength in the right lower limb, loss of sensation and plegia in the left lower limb and urinary incontinence. Initial laboratory workup and CT imaging of the brain, cervical, dorsal and lumbar spine were normal. The patient was admitted to Neurology internment for further study and treatment. During hospitalization, lumbar puncture and MRI of the dorsal and lumbosacral neuraxis were performed, but only allowed us to exclude infectious and compressive etiologies. The inflammatory aetiology was assumed as the most probable, so acute therapy with pulses of methylprednisolone was initiated. In the remaining study, weakly positive anti-MOG (Myelin Oligodendrocyte Glycoprotein) antibodies were detected in the serum. Therapeutic plasmapheresis using a cell separator (which use centrifugal force to separate components according to their density) was proposed as additional therapy. Seven sessions were performed without intercurrences. Results: During acute therapy, there was a partial improvement in sensitivity and strength in lower limbs. The patient started a rehabilitation program with favourable neurological recovery. At the time of hospital discharge, he still needed crutch support for walking and had muscle strength grade 4-/5 bilaterally. Summary/Conclusions: Although the patient maintained some functional limitation and there was not a complete resolution of the neurological symptoms, he showed a good response to acute therapy. The plasmapheresis, by permitting the antibody to be removed faster than would occur by its endogenous clearance, proved to be fundamental in the clinical recovery of the patient. No relationship between COVID-19 vaccination and the event was established.
ABSTRACT
Background: Coronavirus are a family of viruses that can cause respiratory illnesses in human. Special features of Coronavirus is the 'crown like spikes' seen on the surface of the virus. Currently, the entire world are aware of the new strains of the coronavirus that was first reported in Wuhan, China in December 2019 named COVID-19. COVID- 19 pandemic has disrupted the transfusion services in Malaysia in terms of blood collection and potential transfusion needs in total. The pandemic has also caused plausible impact on blood utilization in Hospital Tengku Ampuan Rahimah, Klang, which also the only collection centre in the State of Selangor. Aims: We quantified the impact of COVID-19 on blood utilization in year 2019 until the emerging of COVID-19 pandemic, stratified by most utilized blood products and enumerated blood utilization by different departments. We then specifically analysed the blood utilization in hospitalized COVID-19 patients. Methods: This retrospective cross-sectional study was conducted at Transfusion Medicine Department, Hospital Tengku Ampuan Rahimah Klang from January 2019 to December 2021. Data on transfusion records from Quality Assurance database were collected, summarized and analysed. Overall blood utilization were computed on yearly basis, comparison of blood utilization among respective departments, different type of blood product utilized and overall trend of transfusion in COVID-19 patients were estimated. Results: For the past 3 years, a total of 82,056 units of blood product were utilized. 32,271 units in year 2019, 30,172 units in year 2020, and 19,613 units were used in year 2021. There was a significant reduction in blood utilization after the emerging of COVID-19 pandemic at about 6.50% in 2020 and 39.22% in 2021 compared to year 2019. The most utilized blood product during last 3 years were red cells ranging from 10,516-17,882 units, followed by random platelets 3376-6041 units, and fresh frozen plasma 3739-4662 units. However, there were no significant statistical impact of COVID-19 pandemic observed in utilization of different types of blood product. Average reduction in blood utilization in the year 2020 and 2021 compared to year 2019 in Emergency Department were (44.0%). We have observed a reduction in blood utilization for surgical-based departments, namely Orthopaedic Department (25.9%) and General Surgical Department (22.6%). During the early phase of pandemic in year 2020, the trend of COVID-19 cases was still on the rise and escalated in year 2021 and that was consistent with our findings for hospitalized COVID-19 patients as the red cells transfused in 2020 was only 908 units but in 2021 was 3120 units were transfused which comprised of 8.3% and 29.7% of total red cells utilization. Summary/Conclusions: Following notification of Hospital Tengku Ampuan Rahimah as a State referral and COVID-19 Hybrid Hospital, there was an influx of COVID-19 patients and re-direction of other cases to nearby facilities. Declined blood utilization during COVID 19 pandemic was associated with postponements of elective surgical procedures, reduction in trauma cases due to Movement Control Order and judicious transfusion in COVID-19 patients. An ongoing effective pandemic response and efforts made by various departments had good impact in rationale use of blood products at Hospital Tengku Ampuan Rahimah, Klang.
ABSTRACT
Introduction: Focus of Blood transfusion services is continuous, judicious and well-timed supply of safe Blood. The Severe Acute Respiratory Syndrome-Coronavirus 2 (SARS-CoV-2) pandemic has caused the major disruption throughout the world and declaration of nationwide lockdown by Government of India from 25th March 2020 to 31st May 2020 to halt the spread of virus has afflicted the blood bank services enormously. Aim: To keep the focal point on approaches implemented for safe blood transfusion services during Coronavirus Disease-2019 (COVID-19) pandemic in rural blood bank and to observe how COVID-19 pandemic has affected blood transfusion services in year 2020 with regards to blood collection, supply and organization of camps as compared to year 2019. Materials and Methods: A retrospective study was done in the Blood Bank in a rural tertiary care hospital in Southern India, from January 2019 to December 2020. Various measures were implemented to increase the donor safety and prevention of spread to community and to increase the number of voluntary donors. Statistical analysis performed using Statistical Package for Social Sciences (SPSS) software version 21.0. All data was entered and tabulated in excel sheet. A two sided t-test was utilized for comparing dual variables and one sided Analysis of Variance (ANOVA) for multiple variables. The p-value <0.05 was considered significant. Results: Mean number of units received during pre-COVID-19 year were significantly higher (4468±4127.2) as compared to COVID-19 year 2020 (2282±1856.4) with significant p-value <0.001. Overall utilisation of Packed Red Blood Cell (PRBC) (0.001), Human Platelets (Single Donor Platelets (SDP)/Random Donor platelets (RDP)) p-value 0.003,Fresh Frozen Plasma) FFP (p-value 0.001) was significantly higher in pre-COVID-19 year as compared to COVID-19 year 2020. Total number of camps conducted in pre-COVID-19 year was 41 as compared to 23 in COVID-19 year 2020. Patients deferred for blood donation were much higher in COVID-19 year 2020 (n=400) with maximum (32.5%) under category of self-deferral due to clinical illness as compared to year 2019 (n=200). Conclusion: As a result of our strict and effective implementation of COVID-19 safety protocols, no donor had complained of post donation COVID related symptoms and none of our blood bank staff had developed any COVID-19 related illness. Hence during the COVID-19 pandemic, our blood bank maintained 100% attendance (with staggered duty hours).