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We propose a general novel class of joint models to analyze recurrent events that has a wide variety of applications. The focus in this article is to model the bleeding and transfusion events in myelodysplastic syndrome (MDS) studies, where patients may die or withdraw from the study early due to adverse events or other reasons, such as consent withdrawal or required alternative therapy during the study. The proposed model accommodates multiple recurrent events and multivariate informative censoring through a shared random-effects model. The random-effects model captures both within-subject and within-event dependence simultaneously. We construct the likelihood function for the semiparametric joint model and develop an expectation–maximization (EM) algorithm for inference. The computational burden does not increase with the number of types of recurrent events. We utilize the MDS clinical trial data to illustrate our proposed methodology. We also conduct a number of simulations to examine the performance of the proposed model. [ABSTRACT FROM AUTHOR]

Prior to the advent of recombinant erythropoietin in the late-1980s, blood transfusions were the mainstay of anaemia management in patients with end-stage renal failure, many of whom required “top-up” transfusions every 2 to 4 weeks to relieve the debilitating symptoms of severe anaemia. Erythropoietin therapy, however, allowed for the first time, such patients to achieve a sustained correction of anaemia, and there was a dramatic fall in both the use of red cell transfusions in dialysis units, as well as the associated transfusional iron overload prevalent in dialysis patients. Avoidance of blood transfusions improved access to, and outcomes of, kidney transplantation, due to reduced HLA sensitization. In recent years, however, there have been safety concerns regarding the use of erythropoiesis-stimulating agents (ESAs), and there are signs that the use of blood transfusions is once again increasing. The aim of this review is to reassess how important transfusion avoidance is in 2013, and whether we should still have the same concerns about HLA sensitization that we had 20 years ago. [ABSTRACT FROM PUBLISHER]

A real-world analysis was conducted in Italy among sickle cell disease (SCD) patients to evaluate the epidemiology of SCD, describe patients' characteristics and the therapeutic and economic burden. A retrospective analysis of administrative databases of various Italian entities was carried out. All patients with ≥1 hospitalization with SCD diagnosis were included from 01/2010-12/2017 (up to 12/2018 for epidemiologic analysis). The index date corresponded to the first SCD diagnosis. In 2018, SCD incidence rate was 0.93/100,000, the prevalence was estimated at 13.1/100,000. Overall, 1816 patients were included. During the 1st year of follow-up, 50.7% of patients had one all-cause hospitalization, 27.8% had 2, 10.4% had 3, and 11.1% had ≥4. Over follow-up, 6.1-7.2% of patients were treated with SCD-specific, 58.4-69.4% with SCD-related, 60.7-71.3% with SCD-complications-related drugs. Mean annual number per patient of overall treatments was 14.9 ± 13.9, hospitalizations 1.1 ± 1.1, and out-patient services 5.3 ± 7.6. The total mean direct cost per patient was EUR 7918/year (EUR 2201 drugs, EUR 3320 hospitalizations, and EUR 2397 out-patient services). The results from this real-world analysis showed a high disease burden for SCD patients with multiple hospitalizations during the follow-up. High healthcare resource utilization and costs were associated with patient' management and were most likely underestimated since indirect costs and Emergency Room admissions were not included.

Warm fresh whole-blood transfusion between comrades on the battlefield, also known as "buddy transfusion," has been thrust back into the limelight for several years now. It means drawing blood on the battlefield, once a bleeding soldier needs a transfusion, from one of their uninjured companions and immediately infusing it. It is a lifesaving procedure, effective and hardy. This work aims to answer the main questions that military caregivers might have about it: interest of this procedure, donor and recipient safety, and hemostatic capacity of the blood collected this way., (2022.)

Background: Extremely low gestational age neonates (ELGANs, i.e., neonates born before 28 weeks of gestation) are at high risk of developing retinopathy of prematurity (ROP), with potential long-life visual impairment. Due to concomitant anemia, ELGANs need repeated red blood cell (RBC) transfusions. These produce a progressive replacement of fetal hemoglobin (HbF) by adult hemoglobin (HbA). Furthermore, a close association exists between low levels of HbF and severe ROP, suggesting that a perturbation of the HbF-mediated oxygen release may derange retinal angiogenesis and promote ROP., Methods/design: BORN (umBilical blOod to tRansfuse preterm Neonates) is a multicenter double-blinded randomized controlled trial in ELGANs, to assess the effect of allogeneic cord blood RBC transfusions (CB-RBCs) on severe ROP development. Recruitment, consent, and randomization take place at 10 neonatology intensive care units (NICUs) of 8 Italian tertiary hospitals. ELGANs with gestational age at birth comprised between 24+0 and 27+6 weeks are randomly allocated into two groups: (1) standard RBC transfusions (adult-RBCs) (control arm) and (2) CB-RBCs (intervention arm). In case of transfusion need, enrolled patients receive transfusions according to the allocation arm, unless an ABO/RhD CB-RBC is unavailable. Nine Italian public CB banks cooperate to make available a suitable amount of CB-RBC units for all participating NICUs. The primary outcome is the incidence of severe ROP (stage 3 or higher) at discharge or 40 weeks of postmenstrual age, which occurs first., Discussion: BORN is a groundbreaking trial, pioneering a new transfusion approach dedicated to ELGANs at high risk for severe ROP. In previous non-randomized trials, this transfusion approach was proven feasible and able to prevent the HbF decrease in patients requiring multiple transfusions. Should the BORN trial confirm the efficacy of CB-RBCs in reducing ROP severity, this transfusion strategy would become the preferential blood product to be used in severely preterm neonates., Trial Registration: ClinicalTrials.gov NCT05100212. Registered on October 29, 2021., (© 2022. The Author(s).)

For yet another year, our lives have been dominated by a pandemic. This year in review, we feature an expert panel opinion regarding extracorporeal support in the context of COVID-19, challenging previously held standards. We also feature survey results assessing the impact of the pandemic on cardiac surgical volume. Furthermore, we focus on a single center experience that evaluated the use of pulmonary artery catheters and the comparison of transfusion strategies in the Restrictive and Liberal Transfusion Strategies in Patients With Acute Myocardial Infarction (REALITY) trial. Additionally, we address the impact of acute kidney injury on cardiac surgery and highlight the controversy regarding the choice of fluid resuscitation. We close with an evaluation of dysphagia in cardiac surgery and the impact of prehabilitation to optimize surgical outcomes., (Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.)

We retrospectively compared transfusion rates and early outcomes in 1621 consecutive patients with preoperative anaemia undergoing off-pump coronary artery bypass grafting (OPCAB) or on-pump coronary artery bypass grafting (ONCAB) surgery using a propensity score analysis with inverse probability of treatment weighting. Endpoints were transfusions, early morbidity, and mortality. Surgeries were performed by 45 dedicated OPCAB and/or ONCAB surgeons during the 10-year study period. Operative data did not differ significantly between study groups with the exception of a more frequent use of bilateral internal mammary artery revascularization approach in OPCAB patients than ONCAB patients. OPCAB was associated with fewer transfusions and lower risk for the need of postoperative renal replacement therapy, but higher risk of wound infections than ONCAB. Perioperative stroke risk and 30-day and 1-year mortality did not differ significantly between the groups. Our data in a 'real-world setting' indicate that in patients with preoperative anaemia both ONCAB and OPCAB are feasible surgical approaches regarding early morbidity and mortality., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery.)

Aim: The aim of this review was to compile existing evidence on the role of platelets in the development of severe retinopathy of prematurity (ROP), highlight the strengths and weaknesses of the available studies and critically discuss the reported data., Methods: A comprehensive literature search was conducted on PubMed from January 2000 to January 2022, and the reference lists of the included studies were screened manually., Results: There were 19 primary studies that fulfilled the eligibility criteria. Experimental research indicated lower platelet count in mice oxygen-induced retinopathy model compared with normoxia controls, while platelet transfusions suppressed neovascularisation. The latter finding was not consistently confirmed in clinical research, where a low platelet count, an increased number of thrombopenic episodes and of platelet transfusions have all been implicated in the development of ROP requiring treatment, either type I or aggressive posterior or both. However, existing studies exhibit significant clinical heterogeneity and present methodological limitations that imperil their reliability and validity., Conclusion: Platelet deficiency has been associated with severe ROP. However, critical thresholds of platelet parameters are still unrecognised. Future research is required to determine whether platelet parameters can be predictive biomarkers for ROP requiring treatment and at what thresholds., (© 2022 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.)

Background: The purpose of this study was to compare blood loss, declines in hemoglobin (HgB) and hematocrit (HcT) levels, and required homologous transfusions for patients who either had the femoral intramedullary defect left open or filled with an autologous bone plug during total knee arthroplasty (TKA). We hereby present our results of autologous bone plugs in unilateral TKA. Materials and Methods: A retrospective chart review was performed on 55 patients diagnosed with osteoarthritis (OA) who had undergone unilateral TKA. Twenty six patients had the femoral defect filled with an autologous bone plug and 29 did not. Lateral releases and patella replacements were not performed. Drained blood was reinfused when appropriate. Results: Mean blood loss and mean blood reinfused were similar for the plugged (loss: 960.8 ± 417.3 ml; reinfused: 466.7 ± 435.9 mL) and unplugged groups (loss: 1065.9 ± 633.5 ml, P = 0.38; reinfused: 528.4 ± 464.8 ml, P = 0.61). Preoperative HgB (14.3 ± 1.4 g/dL, P = 0.93) and HcT levels (42.2 ± 4.6%, P = 0.85) were similar across plug conditions. HgB and HcT levels declined similarly for the plugged (2.7 ± 1.2 g/dl and 7.9 ± 4.0%) and unplugged groups (3.0 ± 0.9 g/dl, P = 0.16 and 9.0 ± 2.6%, P = 0.16), respectively. Of patients, one in the plugged group and none in the unplugged group required homologous transfusions (P = 0.5). Conclusion: The autologous bone plug does not appear to reduce the need for homologous blood transfusions following unilateral TKA. [ABSTRACT FROM AUTHOR]

Purpose: In July 2007, the Centers for Medicare and Medicaid Services (CMS) limited coverage of erythropoiesis-stimulating agents (ESAs) in cancer patients with chemotherapy-induced anemia (CIA) through a National Coverage Determination (NCD). The primary objective of this study was to compare transfusion rates in patients with CIA with lung, breast, or colorectal cancer before and after the NCD. Methods: Adult Medicare patients with CIA treated at 49 community oncology clinics were selected from two time periods based on clinics' NCD implementation date. Chart data were abstracted for 12 weeks post-CIA episode start, defined as hemoglobin (Hb) level <11 g/dL while receiving chemotherapy or within 60 days of the last chemotherapy dose. Multivariate analyses were used to calculate the odds of transfusion and to assess the units of blood transfused, controlling for differences in demographics, clinical history, and chemotherapy. Results: Eight hundred pre-NCD and 994 post-NCD patients from 49 sites were selected. Of the patients, 56% used ESAs post-NCD vs. 88% pre-NCD ( p < 0.0001). The duration of ESA use decreased in the post-NCD (32.1 days) vs. pre-NCD (48.4 days, p < 0.0001) group. The post-NCD group reported significantly lower Hb levels, higher odds of receiving a transfusion (odds ratio: 1.41, 95% CI 1.05-1.89, p = 0.0238) and increased blood utilization of 53% (units transfused: OR 1.53, 95% CI 1.15-2.04, p = 0.0034). Conclusions: Decreased frequency and duration of ESA administration were reported in the post-NCD vs. pre-NCD period. Findings were accompanied by a modest but statistically significant increase in transfusions and a decrease in Hb values. [ABSTRACT FROM AUTHOR]

Infections continue to be a serious problem for severely neutropenic oncology and haematopoietic progenitor cell ( HPC) transplant patients. Although it is now possible to collect much larger numbers of neutrophils ( PMNs) from donors stimulated with granulocyte colony-stimulating factor + corticosteroids, the efficacy of these 'modern' granulocyte/ PMN transfusions, with higher doses of PMNs, has not been established by convincing randomized control trials. Accordingly, they cannot be recommended for standard therapy at this time. [ABSTRACT FROM AUTHOR]

ABSTRACT Purpose In July 2007, the Centers for Medicare & Medicaid Services released a national coverage determination (NCD) for erythropoiesis-stimulating agent (ESA) use in cancer patients, mandating payment restrictions likely to reduce ESA use and possibly increase red blood cell transfusions. We aimed to quantify ESA and transfusion use pre-NCD and post-NCD. Methods Medicare 5% sample data, 2005-2007, were used. Patients were 66 years or older, had lung, breast, or colorectal cancer or lymphomas, and initiated chemotherapy in pre-NCD and post-NCD periods (September-November 2006, September-November 2007). ESA use and transfusions were identified from claims. Differences in proportions of patients using ESAs and receiving transfusions pre-NCD and post-NCD were evaluated using logistic regression; differences in transfusion event rates were evaluated using a Poisson model. Results The pre-NCD cohort included 1897 patients and the post-NCD cohort 1877. In the pre-NCD cohort, 31% of patients had lung cancer, 29% lymphoma, 20% colorectal cancer, and 20% breast cancer; distribution was similar in the post-NCD cohort. Overall, ESA use decreased from 35.0% pre-NCD to 15.2% post-NCD. Transfusion use increased from 9.3% to 10.4%, and transfusion event rates from 19.0 to 21.8 per 100 patient-quarters. Results adjusted for baseline characteristics and comorbid conditions were similar. ESA use reduction achieved statistical significance; transfusion use and rate increases did not. Conclusions ESA use decreased sharply post-NCD. This was accompanied by an estimated 1.1% (95% confidence interval −0.8% to 3.0%) absolute increase in transfusion use. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: Most patients with myelodysplastic syndromes (MDS) require transfusions due to chronic anemia. Apart from the acute risks associated with transfusions, chronic anemia and red blood cell (RBC) transfusion dependence impact negatively on survival and quality of life (QoL), and are associated with iron overload, potentially leading to organ damage. QoL studies demonstrate that regular transfusions do not correct the impact of chronic anemia. Furthermore, chronic transfusion support requires substantial resources. Therefore, major goals are to prevent or effectively treat anemia. Indeed, innovative drugs have been shown to be effective in achieving transfusion independence by altering the natural course of MDS. [Copyright &y& Elsevier]

This prospective observational study conducted in a neonatal intensive care unit aimed to evaluate echocardiographic changes provoked by anemia and transfusion of packed red blood cells (pRBCs) in premature infants. In this study, 32 anemic premature infants had serial echocardiographic assessment of left ventricular (LV) systolic performance, LV preload, and afterload immediately before, within 48 h, and up to 120 h after the transfusion of pRBCs. Pretransfusional evaluations also were compared with similar assessments of 71 nonanemic inpatient premature infants analogous for sex, gestational age at birth, and postnatal age. Left ventricular systolic performance was estimated from fractional shortening, LV output, and LV myocardial performance index (LVMPI). The LV preload was estimated from the LV end-diastolic dimension and the ratio of left atrium-to-aortic root dimension (LA/Ao ratio). The LV afterload was estimated from endsystolic wall stress. The LVMPI was found to decrease with increasing corrected gestational age in both the nonanemic (R = 0.173; p = 0.03) and anemic (R = 0.460; p = 0.007) infants. The LVMPI was the only index that changed after transfusion of pRBCs, decreasing in the younger anemic infants (p = 0.011) and increasing in the older anemic infants (p = 0.012). Finally, a significant inverse relationship between pre- and posttransfusional LVMPI values (R = 0.730; p<0.001) was noted. The LVMPI may allow for identification of preterm infants more likely to be helped by transfusion of pRBCs. [ABSTRACT FROM AUTHOR]

Objective: To conduct tests of relationships between different factors that could influence the course of retinopathy of prematurity (ROP) and ROP, particularly the role of hemoglobin variant replacement in adult blood transfusions. Methods: A retrospective, observational study of 83 infants born between 23 and 34 wks gestation was conducted. Results: The infants without ROP, with 1 and 2 stage of ROP and with ≥3 stage of ROP received Q 28 (12-134); 51 (14-149); 156 (38-244) ml/kg of transfused blood, respectively, and the factor Qt was 1,545 (560-10,045); 3,093 (614-13,419); 11,907 (1,288-20,638) (ml/kg)·day, respectively. For the same groups MCV (mean cell volume at the arbitrary time of the 35 wk post-conception) was 92.3 (82.9-110.5); 91.0 (79.3-101.4); 87.1 (80.2-94.8) fl, respectively, and factor P/t was 99.5 (89.2-108.8); 96.3 (84.6-106.3); 90.7 (85.3-96.5) fl, respectively. There is high influence on the stage of ROP of the amount of transfused blood and MCV, both with or without the time factor. The statistical differences between P/t were more significant than the differences between MCV, for different stages of ROP. Conclusions: The influence of the time factor on the statistical differences of MCV but not on the amount of transfused adult blood suggests that HbF - HbA replacement may play a role in ROP development. [ABSTRACT FROM AUTHOR]

Copyright of Der Orthopäde is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Anemia in cancer patients can be treated with transfusions, and 15% of patients with solid tumors are being treated by transfusions. Different cutoff values are used for transfusions, depending on clinical symptoms and patient characteristics, with a hemoglobin (Hb) level of <9 g/dL most commonly used. After the administration of one unit of red blood cells (RBC), the Hb rises with 1 g/dL, and the life span of transfused RBC is 100-110 days. Complications related to RBC transfusion are procedural problems, iron overload, viral and bacterial infections, and immune injury. RBC transfusions have been related to increased risk of the development of non-Hodgkin lymphoma and chronic lymphocytic leukemia, and are related to a worse treatment outcome in selected cancers. In addition, the cost of a transfusion for the patient and society is around 300-500 euros per unit transfused. RBC transfusions should be used carefully to correct anemia in patients with cancer. [ABSTRACT FROM AUTHOR]

Toxoplasma gondii is a protozoan discovered more than a century ago. It is a parasite of great epidemiologic importance which can cause from neurologic complications in the product to fetal death in pregnant women, abortion and encephalitis in patients with AIDS, thus becoming a public health problem in Colombia. In this review of the available evidence, it was concluded that the forms in which the parasite infects human beings are very varied, including the forms known long time ago such as contaminated food, contact with feline feces, as well as other not so well known ways like transfusions, organ transplants, waterborne, and mechanic way, ooquist inhalation and sexual transmission, involving animal species different from felines in the parasite lifecycle, such as dogs and insects. Likewise, the importance of anthropic and environmental factors such as modulators of the transmission dynamics and lifecycle of the parasite are highlighted. This review, provides solid bases for alerting the public health systems about the need to adopt hygienic and sanitary measures to avoid the diffusion of this pathology among high risk populations. [ABSTRACT FROM AUTHOR]

To better understand the detection and management of iron overload in transfusion-dependent patients with myelodysplastic syndromes (MDS), a 15-min web- or paper-based survey was conducted among 338 European physicians from 27 countries. Respondents had a mean of 18 years of clinical experience. Forty-six percent and 27% of physicians noted that detecting and treating iron overload were either "very important" or "important," respectively. The main reason for not actively exploring iron overload was related to poor patient prognosis, while the main reasons for not initiating iron chelation therapy were poor patient prognosis and older patient age. Thirty-seven percent and 31% of physicians believed that treating iron overload in these patients was "very important" or "important," respectively. Ninety percent of physicians prescribed iron chelation therapy, and 38% of transfusion-dependent patients received iron chelation therapy. The key reasons for not initiating iron chelation therapy were related to poor patient prognosis (72%), patient age ≥85 years (50%), and comorbidities (34%). The views of these experienced MDS physicians reflect available international MDS treatment guidelines. [ABSTRACT FROM AUTHOR]

Objective: The use of PRBC includes health risk and has other significant implications. Our objective was to characterize and define the clinical factors that influence PRBC transfusion practice. Design: Prospective study using a validated 11 item questionnaire administered to 43 physicians. Setting: University of Puerto Rico, Neurosurgery Department. Patient and participants: Population included attending physicians (AP) and residents (R). Interventions: Questions included decision making logistics and therapeutic elements: general demographics, reasons for transfusion, quantity given, transfusion threshold, and the expected appropriate hemoglobin (Hb) level for patients with subarachnoid hemorrhage (SAH), traumatic brain injury (TBI), with coronary artery diseases (CAD) or without CAD. Measurements and results: Fifty three percent neurosurgeons responded the questionnaire. 65% were AP and 33% were R. 43% of AP vs 25% of R transfused to increase oxygen delivery, 50% of R vs 38% of AP transfused to avoid ischemic injury, 50% of both AP and R considered that age and disease severity may interfere with adaptation of anemia, therefore needing transfusion, and 50% of AP vs 38% of R to improved safety margin anticipating further blood loss. Threshold for transfusion was a Hb level of 8-10 g/dL (36%) or <7 g/dL (41%). 77% of AP and 63% of R thought the appropriate level of Hb in SAH was 10-12 g/dL. 65% of AP thought that in TBI Hb level should be between 10-12 g/dL and 38% of R answered 8-12 g/dL. 63% of R thought that the appropriate Hb for a post-op patient with CAD was between 10-12 g/dL and 46% of AP answered 10-12 g/dL or >12 g/dL. The appropriate Hb for post-op patient without CAD was 10-12 g/dL, and there was no significant difference between AP and R. Conclusions: Recognizing when to transfuse blood in a neurological critical care patient remains a clinical challenge. Frequent and unwarranted transfusions may worsen outcome of patients. More studies regarding transfusion recommendations in neurological critical care are needed. [ABSTRACT FROM AUTHOR]

Copyright of Revista Española de Cirugía Ortopédica y Traumatologia (English Edition) is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Despite increasing evidence suggesting harmful effects of blood transfusions, physician practices are slow to change. A systematic approach is required to successfully minimize the need for red cell transfusions in the perioperative cardiac surgical patient. This involves preoperative, intraoperative, and postoperative strategies to minimize blood loss and maximize blood conservation. In addition it requires physician education regarding the potential deleterious effects of blood and the more recent evidence that restrictive transfusion strategies are safe and possibly beneficial to postoperative surgical outcomes. In this article, we review the data with respect to blood transfusions in cardiac surgery patients as well as management strategies to minimize the need for blood transfusions in the perioperative period. [ABSTRACT FROM AUTHOR]

Background. Erythropoiesis stimulating agents (ESA) have alleviated the need for blood transfusions in dialysis patients. Their impact on transfusion frequency in elderly chronic kidney disease (CKD) patients aged 65 years and older with non-dialysis-dependent CKD has not been studied. [ABSTRACT FROM PUBLISHER]

Abstract: Background: Limited erythropoietin (Epo) production diminishes neonates'' ability to regenerate blood removed by phlebotomy. Neonates requiring surgery are at risk to receive multiple transfusions. We sought to determine if recombinant Epo administration to neonates requiring surgery would stimulate erythropoiesis. Methods: Infants were randomized in double-masked fashion to receive Epo (200 units kg−1 d−1) or placebo for 14 days. Complete blood count, absolute reticulocyte count (ARC), phlebotomy losses, and transfusions were measured during the study period. Infants were transfused using a strict transfusion protocol. Results: In the Epo group (n = 10, 2034 ± 308 g, 8 ± 2 days old; mean ± SEM), ARC increased significantly, whereas in the placebo group (n = 10, 2400 ± 184 g, 7 ± 2 days old), ARC remained low. Hematocrits in the Epo group trended upward from 34.4 1.7% to 37.3 1.9% (although not statistically significant) despite phlebotomy losses of 53 ± 12 mL/kg. Hematocrits in the placebo group were 35.9 1.8% and 33.2 1.6% on days 1 and 15, respectively, with phlebotomy losses of 27 ± 5 mL/kg. There were no differences in absolute neutrophil counts or platelet counts between groups at the end of the study. No adverse effects were noted. Conclusions: Infants randomized to Epo increased reticulocyte counts and hematocrits without adverse effects. Erythropoietin administration may provide an adjunct to present care in decreasing or eliminating erythrocyte transfusions in surgical neonates. [Copyright &y& Elsevier]

The present study was designed to study appropriateness of use of the blood components in pediatric and neonatal wards. It was an observational study conducted in a tertiary care institute. The patients were selected from various pediatric subsections over a period of six months. All the patients below 12 years of age, who received blood components in any of the pediatric subsections including general pediatric wards, pediatric intensive care unit, pediatric hematology section, neonatal intensive care unit and pediatric surgery ward were included in the study. Each transfusion episode was assessed to decide whether it satisfied the predetermined criteria. Of the total 184 episodes of blood component transfusions, 153 (83.1%) episodes were appropriate and 31 (16.9%) episodes were inappropriate. Among these, fresh frozen plasma transfusions had highest inappropriate [18/41 (58%)] episodes followed by packed red cell transfusions [11/110 (35.5%)] and platelet transfusions [2/5 (6.45%)]. There was no inappropriate episode of cryoprecipitate transfusion. The present study reinforces the importance of blood audit in the clinical setting. Judicious implementation of guidelines for use of various blood products may help decrease the inappropriate use of blood components. [ABSTRACT FROM AUTHOR]

Abstract: Decision-makers at all levels of public health and transfusion medicine have always assessed the risks and benefits of their decisions. Decisions are usually guided by immediately available information and a significant amount of experience and judgment. For decisions concerning familiar situations and common problems, judgment and experience may work quite well, but this type of decision process can lack clarity and accountability. Public health challenges are changing as emerging diseases and expensive technologies complicate the decision-makers'' task, confronting the decision-maker with new problems that include multiple potential solutions. Decisions regarding polices and adoption of technologies are particularly complex in transfusion medicine due to the scope of the field, implications for public health, and legal, regulatory and public expectations regarding blood safety. To assist decision-makers, quantitative risk assessment and cost-effectiveness analysis are now being more widely applied. This set of articles will introduce risk assessment and cost-effectiveness methodologies and discuss recent applications of these methods in transfusion medicine. [Copyright &y& Elsevier]

Sickle cell disease (SCD), the commonest monogenetic disorder worldwide, represents a major public health burden because of its significant morbidity and mortality. Advances in molecular and cellular biology have resulted in an accumulation of knowledge on sickle cell pathophysiology and broadened our understanding of the complexity of this molecular disease with heterogeneous manifestations. Natural history studies and clinical trials have provided incremental data on clinical features, complications, and predictors of severity in SCD and, above all, have laid important recommendations for prevention and treatment of complications. Disease modifying therapies that have significantly improved survival of SCD patients have been identified over recent years. Despite increasingly successful therapies and better overall survival, patients continue to die especially with increasing age and health providers caring for SCD patients face major challenges. This article will highlight modern management of SCD and its impact on the lives of affected patients. [ABSTRACT FROM AUTHOR]

Abstract: The evaluation and management of thrombocytopenia is a frequent challenge for neonatologists, as it affects 22–35% of infants admitted to the neonatal intensive care unit. Multiple disease processes can cause neonatal thrombocytopenia, and these can be classified as those inducing early thrombocytopenia (≤72 h of life) and those inducing late-onset thrombocytopenia (>72 h). Most cases of neonatal thrombocytopenia are mild to moderate, and do not warrant intervention. In approximately 25% of affected neonates, however, the platelets count is <50×109/L, and therapy with platelet transfusions is considered to decrease the risk of hemorrhage. The existing evidence to establish platelet transfusion triggers in neonates is very limited, but it suggests that transfusing platelets to non-bleeding neonates with platelet counts >50×109/L does not decrease the risk of intraventricular hemorrhage (IVH), and that 30×109/L might be an adequate threshold for stable non-bleeding neonates. However, adequately powered multi-center studies are needed to conclusively establish the safety of any given set of neonatal transfusion guidelines. [Copyright &y& Elsevier]

Darbepoetin alfa is an erythropoiesis-stimulating agent (ESA) approved for treating chemotherapy-induced anemia. This phase II, double-blind, placebo-controlled study examined the efficacy of darbepoetin alfa for treating anemia of cancer (AoC) in patients not receiving chemotherapy or radiotherapy. Patients were randomized 3:1 to receive darbepoetin alfa (6.75 µg/kg) or placebo every 4 weeks; the end of the study was at week 17. The primary endpoint was the percentage of patients with a hematopoietic response. Secondary endpoints included transfusion incidence and safety parameters. Efficacy analyses were performed on 162 patients in the darbepoetin alfa group and 56 patients in the placebo group. The Kaplan-Meier percentages of patients who achieved a hematopoietic response (darbepoetin alfa, 69%; placebo, 24%) or achieved the target hemoglobin (darbepoetin alfa, 85%; placebo, 50%) differed significantly between treatment groups. The transfusion incidence did not differ between treatment groups probably because of the low baseline transfusion rates in AoC patients. The incidence of adverse events (including on-study deaths) was similar in both groups. In conclusion, darbepoetin alfa appeared to be well tolerated and significantly increased hemoglobin levels in these AoC study patients. [ABSTRACT FROM AUTHOR]

Erythropoiesis-stimulating agents are indicated for the treatment of chemotherapy induced-anemia in cancer patients. Controlled clinical studies have shown that epoetin alfa consistently and significantly increases levels of hemoglobin (Hb), decreases the need for RBC transfusion, and improves the quality of life that is of such importance in cancer patients with a limited life expectancy. The rise achieved in Hb level correlates with an improvement in quality of life. Studies have also demonstrated that earlier initiation of epoetin therapy (i.e., starting treatment at an Hb level of 10-11 g/dl rather than waiting for Hb to fall to <10 g/dl) is associated with a faster achievement of an optimal Hb level, a lower transfusion requirement, and a maintained quality of life. [ABSTRACT FROM AUTHOR]

Transfusion-related morbidity is an emerging challenge in chronically transfused patients with low-risk myelodysplastic syndromes (MDS). In these patients, transfusion-induced iron overload may represent a leading medical problem. However, although iron-chelating drugs are available, little is known about optimal diagnostic tools, predisposing factors, and the optimal management of these patients. In the current article, we provide recommendations for the diagnosis, prevention and treatment of iron overload in MDS and propose treatment response criteria. Consensus criteria and resulting recommendations were discussed and formulated by members of the MDS platform of the Austrian Society of Haematology and Oncology in a series of meetings and conferences in 2006 and 2007. These recommendations should facilitate and assist in recognition of iron overload, selection of patients, timing of treatment, drug selection and the measurement of treatment responses. [ABSTRACT FROM AUTHOR]

The article focuses on the results of an open-label study that aims to assess the correlation between changes in hemoglobin and symptom burden affecting health-related quality of life (HRQOL) in cancer patients with chemotherapy-induced anemia (CIA) treated with darbepoetin-α administered as a fixed dose every 2 weeks. It mentions that darbepoetin-α is routinely used to stimulate red blood cell (RBC) production.

Blood transfusions are common in the hospital setting. Despite the large commitment of resources to the delivery of blood components, many clinicians have only a vague understanding of the complexities associated with blood management and transfusion therapy. The purpose of this primer is to broaden the awareness of health care practitioners in terms of the risks versus benefits of blood transfusions, their economics, and alternative treatments. By developing and implementing comprehensive blood management programs, hospitals can promote safe and clinically effective blood utilization practices. The cornerstones of blood management programs are the implementation of evidence-based transfusion guidelines to reduce variability in transfusion practice, and the employment of multidisciplinary teams to study, implement, and monitor local blood management strategies. Pharmacists can play a key role in blood management programs by providing technical expertise as well as oversight and monitoring of pharmaceutical agents used to reduce the need for allogeneic blood. [ABSTRACT FROM AUTHOR]

Background and objectives: During the last decade many aspects of haemostasis and coagulation management greatly changed in cardiac surgery. On one side, new anti-platelet agents entered the market and became more and more widely used; on the other one, point-of-care monitoring tools are nowadays available for perioperative use. The present survey is aimed to investigate the perioperative haemostasis and coagulation management in European Cardiac Surgery Institutions. Methods: A questionnaire exploring different aspects of perioperative haemostasis and coagulation management was sent to 320 Cardiac Surgery Institutions in Europe. Results: 82 Institutions replied to the survey. Due to the poor quality of the data collection, 9 Institutions were excluded. A pool of 73 questionnaires coming from 24 different Countries was analyzed. Non-routine coagulation tests (antithrombin activity) are done in 34% of the Institutions before the operation and in 23% after the operation. Point-of-care tests are applied as a preoperative routine in 9.9% of the Institutions (thromboelastography, 5.7%; PFA-100, 1.4%; others, 2.8%) and in selected patients in 50% of the Institutions. Postoperative point-of-care test are applied in 17.9% of the Institutions (thromboelastography, 2.7%; PFA-100, 1.4%; others, 13.8%). Allogeneic blood products use widely differs among Institution: packed red cells are used in 47.5% of the patients (range 8%–90%), fresh frozen plasma in 29% (2%–100%) and platelets in 12.4% (0%–50%). Conclusions: Perioperative haemostasis and coagulation management is widely different among European Institutions. Point-of-care coagulation and platelet function tests are gaining a significant role. Transfusional policy appears strongly Institution-dependent. [ABSTRACT FROM AUTHOR]

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Thrombocytopenia occurs at various grades of severity in patients with malignancies undergoing myelosuppressive chemotherapy. In most instances, this is the major dose-limiting hematologic toxicity, especially in the treatment of potentially curable cancers. The standard preventive measure against chemotherapy-induced thrombocytopenia has been dose reduction and/or dose delay. This can often lead to poor outcomes, including reduced disease free periods and overall survival. With the availability of a platelet growth factor, recombinant human interleukin (IL)-11, an effective way to prevent chemotherapy-induced thrombocytopenia and accelerate platelet recovery, can now be provided to patients. The use of recombinant human IL-11 has also been extended to include patients with prolonged thrombocytopenia, such as those with bone marrow failure syndromes. With the use of recombinant human IL-11 in both malignant and non-malignant conditions, adverse reactions often seen with platelet transfusions, such as transfusion reactions, viral and bacterial infections and platelet refractoriness, can now be decreased or avoided. [ABSTRACT FROM AUTHOR]

OBJECTIVES. Erythropoietin is frequently administered to premature infants to stimulate erythropoiesis. The primary goal of erythropoietin therapy is to reduce transfusions, but the efficacy of erythropoietin has not been convincingly demonstrated in this regard. The aim of this trial was to investigate whether combined administration of vitamin B12, folic acid, iron, and erythropoietin could decrease transfusion requirements in extremely low birth weight infants. PATIENTS AND METHODS. In a randomized, controlled trial, extremely low birth weight infants with a birth weight ≤800g and a gestational age ≤32 weeks were randomly assigned to a group receiving combination treatment or a control arm. RESULTS. The treatment increased levels of folate in red blood cells, vitamin B12, ferritin, transferrin receptor levels in plasma, and reticulocyte counts. The proportion of infants requiring no transfusions was lower in the treatment group (38%) as compared with controls (5%). The treatment group and the need for mechanical ventilation were independent predictors of the number of transfusions in multiple regression analysis. Cox regression analysis indicated that combined therapy resulted in a 79% risk reduction for any transfusion. CONCLUSION. Combined treatment with erythropoietin, intravenous iron, folate, and vitamin B12 during the first weeks reduces the need for transfusion in extremely low birth weight infants. [ABSTRACT FROM AUTHOR]