Does the use of infusion pumps increase hemolysis during blood transfusion in patients with thalassemia?

BACKGROUND: Patients with thalassemia need regular blood transfusions to maintain normal growth and suppression of ineffective erythropoiesis. Packed red blood cell (RBC) units can be delivered by infusion pumps (IPs); however, IPs may cause mechanical stress-induced RBC lysis. This study aimed to investigate the biomarkers of hemolysis related to transfusion techniques in patients with thalassemia. MATERIAL AND METHODS: Eighty-one thalassemia patients compared to those 42 healthy controls in terms of hemolysis markers (hemoglobin, plasma free hemoglobin (Hb), haptoglobin, potassium (K), lactate dehydrogenase (LDH)) before transfusion. Considering the age and peripheral venous diameter of the patient, the physician decided on the caliber of vascular access device (22 G or 24 G) for transfusion and the method to be used (gravitational method [GM] or IP). Hemolysis markers were repeated after transfusion in thalassemia patients. RESULTS: Packed RBC units were transfused to 24 (30 %) patients by IP and 57 (70 %) patients by GM. Plasma free Hb was significantly increased from 4.76 ± 7.92 mg/dL to 9.01 ± 7.66 mg/dL following transfusion (p < 0.001). There was no significant difference between IP and GM in terms of plasma free Hb increase. Post-transfusion plasma free Hb, LDH, and K levels significantly increased in patients who were transfused with 24 G catheters compared to those transfused with 22 G. CONCLUSION: An elevation in LDH levels was detected after transfusion with volumetric IPs; however, plasma free Hb or K levels were not affected by the transfusion method. Studies are needed to determine the factors associated with hemolysis after transfusion.

Antibody response after a booster dose of BNT162B2mRNA and inactivated COVID-19 vaccine.

Introduction: The necessity of a booster dose is a matter that has not been as yet illuminated, although it is noted that neutralizing antibody titers decrease over time. We aimed therefore to evaluate antibody titers and seroconversion rates after a booster mRNA vaccine and a booster inactivated vaccine. Methods: A total of 322 participants were divided into three main groups, with two subgroups each, based on their vaccinations and previous infection history. The levels of anti-SARS-CoV-2 Ig-G were analyzed with the Elecsys® Anti-SARS-CoV-2 S assay. Results: The antibody titers showed a linear and significant increase from one vaccine group to the other, displaying progressive changes from group 2IV to group 3IV, and then to group 2IV/mRNA. All of the seronegative participants were in the 2IV(-) subgroup; 93.3% of the participants whose antibody titers were above the upper limit were in the 2IV/mRNA group. Doctors were much more inclined to have a booster dose and mRNA vaccines than nurses. The status of being a doctor increases the rate of having a booster dose 7.8 times; likewise, each annual increase in age increases the rate 1.05 times. Conclusion: Anti-SARS-CoV-2 IgG levels decrease over time. The antibody response rate to only two doses of the inactivated vaccine was meager, so a booster dose is necessary to maintain the effectiveness of inactivated vaccines. The third dose of the vaccine, especially that of the mRNA vaccine, which was found to be much more superior to the inactivated vaccine, should be strongly recommended.

Potential and promising marker for serious bacterial infections in children: Delta neutrophil index.

AIM: This study aimed to evaluate the usefulness and accuracy of the delta neutrophil index (DNI), an index expressing the number of immature granulocytes as a proportion of the total, as an inflammatory marker in predicting serious bacterial infections (SBIs). METHODS: Paediatric patients admitted to our hospital with fever were divided into four groups: SBI, non-SBI, COVID-19 and control group. White blood cell count, absolute neutrophil count, C-reactive protein and the DNI were recorded, and their accuracy in predicting SBI was evaluated. RESULTS: Mean DNI was 4.96 ± 8.38 in the SBI group (150 patients), 0.67 ± 1.68 in the non-SBI group (397 patients), 0.29 ± 0.99 in the COVID-19 group (112 patients) and 0.14 ± 0.21 in the control group (102 patients). The DNI was significantly higher in the SBI group compared with the non-SBI (P < 0.001); the non-SBI group also had higher levels than the COVID-19 group (P = 0.005). One percent increase in the DNI increased the SBI rate 1.36 times (odds ratio 1.36 (95% confidence interval 1.23-1.49), P < 0.001). Based on the determined cut-off value (>2.5%), the DNI (odds ratio 6.27 (95% confidence interval 3.85-10.21), P < 0.001) significantly predicted SBIs with 90.4% specificity and 47.7% sensitivity. CONCLUSIONS: SBIs in childrenare associated with an increase in DNI levels. Compared to other biomarkers, the DNI had higher specificity in predicting SBIs. The DNI may also be usefulin differentiating bacterial and non-bacterial infections in individualclinical syndromes. Currently, there is no evidence that serum DNI aids indifferentiating COVID-19 and upper respiratory tract infection.