Associated Factors With Acute Transfusion Reaction From Hospital Online Reporting Events: A Retrospective Cohort Study.

OBJECTIVES: In our hospital's hemovigilance system, a Wi-Fi-based vital signs monitor that automatically transmits data to ensure patient safety has been implemented. We derived the potential clinical characteristics for subsequent association of acute transfusion reactions (ATRs) using the hospital information system database. METHODS: We retrospectively analyzed multiple factors to identify the possible associations between clinical factors and developing ATRs. The following data were collected: recipient's pretransfusion and posttransfusion vital signs, clinical and laboratory characteristics, and presence of ATRs. RESULTS: In all, 44,691 events were analyzed. Of these, ATR events occurred in 1586 (3.5%). Logistic regression analysis revealed that leukopenia (<5×10/µL) before transfusion was shown a statistically associated with developing mild ATRs (odds ratio [OR] = 2.38, 95% confidence interval [CI] = 1.68-3.35, P < 0.001). The association between elevated body temperature (forehead temperature > 37.5°C) and moderate ATRs was significant (OR = 1.55, 95% CI = 1.22-1.98, P < 0.001). In addition, the association between high diastolic pressure (>90 mm Hg) and severe ATRs was significant (OR = 1.78, 95% CI = 1.06-2.99, P = 0.03). Therefore, evaluated patient's status such as vital signs before transfusion is very important. In addition, every hospital should established a complete hemovigilance program focus on effectively reporting and real-time monitoring ATRs to improve transfusion patient safety. CONCLUSIONS: Vital signs monitoring and leukocyte counts before transfusion were significantly associated with the subsequent risk of ATRs. When patients with elevated body temperature, leukopenia, and high diastolic pressure who are scheduled to receive transfusion, clinicians should be aware of increasing the risk of ATRs in these patients.

Insidious malignant triton tumor of the chest wall with late flare-up.

Malignant triton tumor is a rare malignant peripheral nerve sheath tumor with rhabdomyoblastic differentiation. Most of these tumors are located in the head, neck, and extremities, and about half of cases are associated with neurofibromatosis type 1 featuring cafe-au-lait spots or cutaneous neurofibromas. We present a 76-year-old man with an insidious chest wall tumor with late progressive painful enlargement and pleural and pulmonary involvement. Complete resection of the affected thoracic wall as well as single separate lesions in the parietal pleura and left upper lung was carried out. The pathological examination confirmed that it was a malignant triton tumor. The patient received adjuvant chemo-radiotherapy but eventually succumbed to disease relapse and distant metastases 6 months after the surgery.

Iron chelation therapy for patients with myelodysplastic syndrome.

Chronic blood transfusions are necessary for patients with hereditary anemia such as thalassemia, and for patients with myelodysplastic syndrome (MDS) who become anemic and transfusion-dependent. A common consequence of chronic transfusion is iron accumulation that can lead to organ damage. While there is general agreement regarding the value of iron chelation therapy to reduce the detrimental effects of iron overload in thalassemia major, the same is not true for MDS. The malignant nature of the disease and the relatively high cost of iron chelation therapy make cost-effectiveness an issue of great concern. Furthermore, the positive assessment of a drug's cost-effectiveness in one country does not necessarily justify its use in another country. More prospective studies are needed to identify the best iron chelator for patients with MDS as well as to identify those patients who will benefit most from iron chelation therapy.

Correlation between characteristics of unrelated bone marrow donor and cell density of total nucleated cell in bone marrow harvest.

The relationship between the features of bone marrow donor and the quality of marrow harvest has been unclear because most of bone marrow registries have multiple collection centers with somewhat different harvest procedures. We are able to address this issue for Tzu Chi General Hospital is the only collection center affiliated with Tzu Chi Taiwan Bone Marrow Registry. Between November 1997 and March 2002, data of 286 healthy unrelated donors was analyzed to correlate with the cell density of total nucleated cell in bone marrow harvests. The harvest procedure was standardized by single-hole harvest needle under general anesthesia. The operation staffs were restricted within the members of Oncology-Hematology division. The results showed that the cell density of bone marrow harvest was positively correlated with donor body weight and peripheral white blood cell count P = 0.0475, P < 0.0001, but negatively correlated with the total volume of bone marrow harvest P < 0.0001. We recommend that if multiple human leukocyte antigen-matched donors are available, donor with higher body weight and/or higher white blood cell count be selected for allogeneic bone marrow transplantation.

A phase II study of weekly paclitaxel and epirubicin in recurrent or refractory squamous cell carcinoma of the head and neck.

OBJECTIVE: The combination of taxanes and anthracyclines has been proved to be active for treatment of many cancers. We conducted a phase II study to determine the response and toxicity of paclitaxel and epirubicin (TE) in patients with incurable squamous cell carcinoma of the head and neck (SCCHN). METHODS: Patients with metastatic or recurrent SCCHN and adequate hematologic, renal and hepatic function and a Karnofsky performance status >/=60% were enrolled. Prior chemotherapy and/or radiotherapy were permitted with 4-week interval. The regimen was paclitaxel 60 mg/m(2) and epirubicin 20 mg/m(2), on Days 1, 8 and 15, as an intravenous infusion, repeated every 28 days. Patients with disease progression or unacceptable toxicity were excluded from the study. RESULTS: The current study was intended to treat 43 patients but closed at the planned interim analysis due to early evidence of insufficient efficacy than expectation. Fifteen patients with a median age of 52 years (range, 37-72 years) were accrued. Previously, most patients had received radiotherapy and chemotherapy, and a majority (87%) of patients had treatment-free interval of <6 months. Median Karnofsky performance status was 70% (range, 60-90%). There was one clinical response (7%) and another three (20%) had stable disease. Median overall survival time was 4.5 months. The most common major toxicity was infection (47%), which caused four treatment-related mortalities. Grade 3-4 neutropenia occurred in five patients, but other toxicities were mild and manageable. CONCLUSIONS: In the population with majority of refractory disease of SCCHN, the response rate to TE was lower than expected. Such dose schedule is not recommended unless in chemotherapy naïve patients or in combination with newer agents.