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OBJECTIVE: Nursing professionals are expected to have updated knowledge of clinical blood transfusion guidelines while catering to cancer patients requiring bedside transfusions. METHODS: A cross-sectional study was conducted to evaluate the knowledge and current practice of nurses at a tertiary-level cancer hospital in rural Kerala using a pretested self-administered structured 20-item questionnaire, and results were analyzed. RESULTS: Among 246 nurses who participated, a response rate of 93.08% (n = 229) was obtained. Mean scores of 4.64 ± 1.20 out of eight for knowledge-based questions (58.00%) and 6.16 ± 1.49 out of 12 for practical aspects (51.33%) were obtained among respondents. Whereas overall scores were fair (84.28% and 65.94% nurses scoring ≥50% in knowledge-based and practice-based questions, respectively), we noticed poor knowledge-level scores for the key aspects such as time taken for cross-matching, cross-match test taking least time, storage temperature, and mandatory transfusion-transmitted infection tests before initiating transfusion. Poor scores were also noted for key clinical practices relating to warming of blood products, posttransfusion patient monitoring, rate of nonemergency blood transfusions, administration of premedications, and disposal of blood bags among the respondents. Data also revealed that there was a lack of adherence to a uniform cannula size for routine blood transfusion among nurses. Work experience or qualification had no significant relation to the nurses' scores for knowledge or practice-based questions. CONCLUSIONS: Overall, a fair amount of theoretical and practical knowledge about bedside transfusion practices were observed among nurses with some inconsistencies not related to qualification or work experience. This illuminates inherent lacunae in the existing training system and merits urgent redressal.
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COVID-19 is one of the deadliest viral infections to have hit the planet. There is urgent need to bridge the gaps in handling this pandemic by methodically synthesising available literature through a unique holistic perspective. A systematic review of articles regarding emergency and primary care during COVID-19 pandemic was carried out. PubMed, Scopus, Science Direct, Web of Science, and Google Scholar were screened for articles and qualitative data across various studies were coded and thematically analyzed. Narrative synthesis was achieved by themes identified from findings of studies. Out of n = 953 articles retrieved, we identified and critically appraised n = 7 articles of which n = 5 were narrative reviews, one was systematic review and one was scoping review from researchers across ten countries. Nine overlapping themes were identified under three broad domains - clinical understanding of the disease, social aspects of the disease, and its contextual implications during pandemic. This narrative synthesis draws up a holistic picture of recent reviews on clinical and social understanding of COVID-19 as a disease and as a pandemic. The overlap among nine themes identified in this review could mean that primary care-level screening, triaging, referral, and emergency care of COVID-19 patients in the backdrop of current clinical understanding of the pandemic are all intertwined. Coping with COVID-19 co-habitation and managing undifferentiated illnesses require a syndromic approach and deft handling at grass root levels. Inclusive health policy empowering inherent holistic specialties like family medicine and emergency medicine could be the prudent way forward during this pandemic.
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A 72-year-old female with co-morbidities posted for surgical correction of fracture neck of femur without any history of transfusions was noted to have a hemoglobin level of 7 g/dl and packed red blood cells transfusion was ordered. Pretransfusion tests demonstrated A1B group with D positive on forward grouping. Reverse grouping showed a varying grade of agglutination with A, B, and O cells. Agglutination being stronger at 4°C. Antibody screening showed pan-agglutination, direct Coomb's test and auto control were negative. The serum reacted with adult O cells (OIadult) but not with adult Bombay cells (Oh Iadult) or O cord (Oicord) cells. A possibility of a compound cold antibody anti IH was made and A1B compatible cells were transfused to the patient. This case report illustrates anti-IH cold agglutinin with broad thermal amplitude. Uniqueness of this case report was O group incompatibility with A1B group, which was detected earlier and a catastrophic transfusion reaction being subverted.