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Fulltext Serum soluble transferrin receptor concentration as a biomarker of erythropoietic activity: surrogate marker of adequate transfusion in adult beta-thalassaemia intermedia patients

Thambiah, S., George, E., Nor Aini, U., Sathar, J., Zarida, H., Mokhtar, A.B.

Malaysian Journal of Medicine and Health Sciences, 2013;9(2):3-12.
MyJurnal

Management of Beta (β)-thalassaemia intermedia in contrast to β-thalassaemia major patients has no clear guidelines as to indicators of adequate transfusion. Regular blood transfusion suppresses bone marrow erythropoietic activity. Serum soluble transferrin receptor (sTfR) concentration is a marker for erythropoietic activity, with increased sTfR being associated with functional iron deficiency and increased erythropoietic activity. This study aimed to determine the use of sTfR as an indicator of adequate transfusion in adult β-thalassaemia intermedia patients. A cross-sectional study was conducted at Hospital Ampang, Malaysia, for six months. Patient group included six β-thalassaemia intermedia and 34 HbE-β-thalassaemia transfused patients. None of the patients were on regular monthly blood transfusions as in β-thalassaemia major. The control group comprised of 16 healthy subjects with normal haematological parameters. Haemoglobin (Hb) analysis, sTfR and ferritin assays were performed. Hb and HbA percentages (%) were found to be significantly lower in patients compared to the controls, while HbE%, HbF%, sTfR and ferritin were significantly higher in patients. An inverse relationship was found in the controls between HbF% with Hb (r = -0.515, p < 0.05) and HbA% (r = -0.534, p < 0.05). In patients, sTfR showed an inverse relationship with HbA% (r = -0.618, p = 0.000) and a positive correlation with HbE% (r = 0.418, p = 0.007) and HbF% (r = 0.469, p = 0.002). Multivariate analysis showed that HbA% (r = 2.875, p = 0.048), HbE% (r = 2.872, p = 0.020) and HbF% (r = 2.436, p = 0.013) best predicted sTfR independently in patients. Thus, sTfR is a useful marker for erythropoiesis. The elevated sTfR in these patients indicate that the transfusion regimen used was inadequate to suppress ineffective erythropoiesis. Hb levels may not be the best target for monitoring transfusion treatment in β-thalassaemia intermedia patients, but the use of sTfR is helpful in individualising transfusion regimens.

Matched MeSH terms: Blood Transfusion
Fulltext A retrospective review of 25 cases of lethal fetal anomalies

Dalia, F.A., Hamizah, I., Zalina, N., Yong, S.L., Mokhtar, A.

International Medical Journal Malaysia, 2016;15(1):19-23.
MyJurnal

Introduction: To review the gestational age at diagnosis, method of diagnosis, pregnancy outcome and
maternal complications of prenatally diagnosed lethal foetal anomalies. Methods: Retrospective review of 25
women who had aborted or delivered foetuses with lethal anomalies in a tertiary hospital in 2011 based on
patient medical records. Results: There were a total of 10,088 deliveries, in which 25 (0.24%) women were
found to have conceived foetuses with lethal anomalies. All of them were diagnosed by prenatal ultrasound
and only 7 (28.0%) had both prenatal ultrasound and genetic study done. The women’s mean age was 29.9
years old. The mean gestational age at diagnosis of lethal foetal anomalies was 25.5 weeks (SD=12.5) and
mean gestational age at termination of pregnancy (TOP) or delivery was 28.5 weeks (SD=12.5). Seven (28%)
women had early counseling and TOP at the gestation of < 22 weeks. Beyond 22 weeks of gestation, eight
(32%) women had TOP and ten (40%) women had spontaneous delivery. Twenty (80%) women delivered or
aborted vaginally, three (12%) women with assisted breech delivery and two (8%) women with abdominal
delivery which were performed due to transverse foetal lie in labour and a failed induction, leading to
emergency hysterotomy complicated by hysterectomy due to intraoperative finding of ruptured uterus.
Overall, the associated post-partum adverse events included post-partum haemorrhage (12%), retained
placenta (12%), blood transfusion (8%), uterine rupture (4%) and endometritis (4%). Mean duration of hospital
stay was 6.6 days (SD 3.7 days). Conclusion: Late diagnosis of lethal foetal anomalies leads to various
maternal morbidities, in this case series , which could have been prevented if they were diagnosed and
terminated at early trimester. A new direction is needed in our local practice.

Matched MeSH terms: Blood Transfusion
Fulltext Reduction of tear-drop poikilocytes in a case of myelofibrosis following splenectomy

Chooi, Fun Leong, Soon, Keng Cheong

Medicine & Health, 2006;1(1):81-84.
MyJurnal

Myelofibrosis is a chronic myeloproliferative disorder characterised by splenomegaly, leukoerythroblastic anaemia, tear-drop poikilocytosis and marrow fibrosis. Splenectomy is indicated for patients requiring frequent transfusions or massive splenomegaly causing distressing symptoms and severe thrombocytopenia secondary to hypersplenism.A 56 year-old lady diagnosed to have primary myelofibrosis in year 2000 was referred to HUKM for further management of her increasing requirement of blood transfusion and massive splenomegaly. She has had two episodes of acute cholecytitis. Investigations done in our hospital showed that her hemoglobin level was 6.4g/dl, white cell count of 23.4x109/l, platelet count 163x109/l and peripheral blood showing leukoerythroblastic picture and tear-drop poikilocytosis. Leukocyte alkaline phosphatase score (NAP) was 184/100 neutrophils. Ultrasound of the abdomen showed massive splenomegaly with multiple gall stones. In view of the frequent transfusion requirements and symptomatic massive splenomegaly, splenectomy and cholecystectomy was performed. A review of her peripheral blood picture, post-splenectomy, showed marked reduction of the tear-drop poikilocytosis and leukoerythroblastosis. We believe that the spleen plays an important role in their formation, but the exact mechanism remains unclear.

Matched MeSH terms: Blood Transfusion
‘Emergency chemotherapy’ for bleeding cervical cancer: case series

Shafiee, M.N., NorAzlin, M.I., Lim, P.S., Arifuddin D, Trika I, Hatta, D.

Journal of Surgical Academia, 2012;2(2):35-37.
MyJurnal

Fulminant haemorrhage in cervical cancer leads to severe anaemia and haemodynamic instability. Palliative management includes vaginal packing as temporary measure, radiotherapy and other invasive surgical procedures. High dose emergency chemotherapy is not commonly implemented particularly when complicated with anaemia and renal impairment. We discuss three case series on the usefulness of high dose chemotherapy to combat bleeding from cervical cancer as an emergency treatment. The first case was clinically staged as operable 2A disease with severe anaemia due to bleeding from the tumour mass. The haemoglobin was corrected by blood transfusion while the bleeding was being arrested by high dose chemotherapy. The second case was inoperable with invasion to the bladder mucosa. She had frank haematuria and bleeding from the tumour with severe anaemia. A course of chemotherapy and blood transfusion controlled the bleeding and anaemia was corrected. The third case presented late with obstructive uropathy and anaemia. She required dialysis, blood transfusion and high dose emergency chemotherapy to stop the bleeding before undergoing urinary diversion after an unsuccessful ureteric stenting. High dose chemotherapy consisting cisplatin, vincristine, bleomycin and mitomycin-C has a clinical value in arresting fulminant haemorrhage in cervical cancer.

Matched MeSH terms: Blood Transfusion
Current issues in the management of thalassaemia

Rahman Jamal

Malaysian Journal of Child Health, 1998;10(1):1-8.
MyJurnal

The thalassaemias are the commonest single gene disorders amongst the inherited diseases. In Malaysia, there are an estimated 2200 transfusion dependent thalassaemia patients. With a carrier rate of 3-5%, 120-340 new cases of thalassaemia are expected to be born each year. The reference treatments for these patients are regular blood transfusions and iron chelation therapy. With optimal management, these patients are able to survive into the third or fourth decade of life and most importantly avoid the complications related to transfusions and iron overload. The use of desferal locally is still limited to only those who can afford i.e. about 30% of the cases. Treatment for some of the complications such as hepatitis C, diabetes mellitus, growth impairment and pubertal delay, are now available. Curative treatment approaches like bone marrow transplantation have now become standard treatment for eligible cases whilst cord blood transplantation may yet offer hope for those who are without compatible sibling donors. Research on globin gene therapy looks very promising but will probably take some time to deliver. Hb F switching is a very novel idea but so far the results are mainly anecdotal. Finally, the strive for optimal management of thalassaemia must come hand in hand with a prevention programme to achieve a reduction of new cases.

Matched MeSH terms: Blood Transfusion
Fulltext A cross-sectional survey of knowledge and attitude towards HIV/AIDS patients among nursing students in teaching hospital

Hamidah Othman, Noor Azizah Mohd Ali

The Malaysian Journal of Nursing, 2017;8(3):27-34.
MyJurnal

HIV/AIDS is a matter of concern and has become a pandemic disease that threatens the world population. It
has remained one of the priorities in global public health challenges. Caring for people with HIV/AIDS
requires clinical expertise as well as high-quality skills for health care providers. The purpose of the study was
to examine knowledge and attitude on HIV/AIDS patients among nursing students. A cross-sectional study
was conducted in Public University at Wast Cost Malaysia. The 126 respondents of nursing students agreed to
participate in the study using a self-administered questionnaire that was designed and modied after reading
and referring to articles, books, and journals. The results of the research revealed that nursing students, in
general, have a satisfactory knowledge (mean score 30.71), but had a moderate attitude toward HIV/AIDS
patient with total mean score 2.34. Most of the students (89.3%) get the knowledge regarding HIV/AIDS
through the internet. The majority of the students knew that blood transfusion (99.4%) and sharing
needles/syringe (99%) were the higher sources HIV/AIDS modes of transmission. Most of the students agreed
that peoples with HIV/AIDS should be treated in society with support from the community (97.0%). Although
the knowledge level of nursing students seems to be satisfactory, but they still showed the moderate attitude
towards HIV/AIDS patients. Thus, structured education programmes should be conducted by nursing faculty
to ensure that nursing students gain the necessary accurate knowledge and an appropriate attitude towards the
care of HIV/AIDS patients.

Matched MeSH terms: Blood Transfusion
Knowledge, attitude and practice towards dietary iron among patients with thalassemia and their caregivers in Peninsular Malaysia

Chin DM, Kader Maideen SF, Rashid A

Med J Malaysia, 2019 Oct;74(5):365-371.
PMID: 31649210

INTRODUCTION: Thalassemias are the most common human monogenic disorders in the world. Regular blood transfusion and increased intestinal absorption of iron among thalassemia patients will lead to iron overload, which will not only markedly decrease their life expectancy but also pose a heavy burden to the healthcare system. The objective of this study was to evaluate the level of knowledge, attitude and practice towards dietary iron among thalassemia patients and their caregivers.
METHODS: An analytical cross-sectional study using purposive sampling method was conducted at eight thalassemia societies in Peninsular Malaysia. 260 respondents comprised of patients and caregivers were assessed with two separate sets of questionnaires.
RESULTS: Knowledge on dietary iron among the respondents was unsatisfactory, despite them having good knowledge on thalassemia disorder. Female patients were found to have better dietary knowledge, attitude and practice compared to males. The percentage of caregivers with good attitude and good practice were significantly higher compared to adult patients. Caregivers with children on iron chelators were noted to have better dietary attitude and practice. Thalassemia knowledge and children on vitamins were found to be the predictors of dietary knowledge among the patients and caregivers respectively.
CONCLUSION: The level of knowledge on dietary iron among the patients and caregivers was unsatisfactory in spite of their attitude and practice towards dietary iron were good. Effective delivery of dietary information to the patients and caregivers is essential to enable them to choose a healthy diet for their condition.

Matched MeSH terms: Blood Transfusion
Fulltext Factors influencing transfusion requirement in patients undergoing first-time, elective coronary artery bypass graft surgery

Mazlan AM, Ayob Y, Hussein AR, Namasiwayam TK, Wan Mohammad WMZ

Asian J Transfus Sci, 2017 Jul-Dec;11(2):95-101.
PMID: 28970674 DOI: 10.4103/ajts.AJTS_51_16

CONTEXT: Coronary artery bypass graft (CABG) operation is associated with high frequency of allogeneic blood transfusion due to the acquired hemostatic challenges in patients undergoing CABG. However, allogeneic blood transfusion carries risks of infection, adverse reaction, and mortality as well as prolonged hospital stay and increased hospital cost. It is important to identify patients who require blood transfusion to mitigate their risk factors and reduce the chance of exposure to allogeneic blood.

AIMS: This study was conducted to evaluate factors that influence the decision to transfuse red cell in first-time elective CABG patients.

SETTINGS AND DESIGN: This was a cross-sectional study based on a retrospective record review. The study was done in the National Heart Institute.

MATERIALS AND METHODS: All patients who underwent first-time elective CABG were included in this study. Variables analyzed include age, gender, body weight, preoperative hemoglobin (Hb) level, patients' comorbidities, and other clinical parameters.

STATISTICAL ANALYSIS USED: Data were analyzed using SPSS software version 20.

RESULTS: A total of 463 patients underwent first-time elective CABG during the period of the study. Three hundred and eighty-six (83.4%) patients received red cell transfusion. From multiple logistic regression analysis, only age (odds ratio [OR] = 1.040, 95% confidence interval [CI]: 1.003, 1.077, P = 0.032), body weight (OR = 0.951, 95% CI: 0.928, 0.974, P < 0.001), Hb level (OR = 0.500, 95% CI: 0.387, 0.644, P < 0.001), and cardiopulmonary bypass time (OR = 1.013, 95% CI: 1.004, 1.023, P < 0.001) were the significant independent predictors of red cell transfusion.

CONCLUSIONS: By stratifying patients according to their risk factor for red cell transfusion, the high-risk patients could be recognized and should be enrolled into effective patient blood management program to minimize their risk of exposure to allogeneic blood transfusion.

Matched MeSH terms: Blood Transfusion
Fulltext A survey of hysterectomy patterns in Malaysia.

Ravindran J, Kumaraguruparan M

Med J Malaysia, 1998 Sep;53(3):263-71.
PMID: 10968164

A prospective cross-sectional study involving 14 government hospitals was undertaken for a period of 6 months in Malaysia to study the patterns of hysterectomy for gynaecological indications. A total of 707 patients were enrolled in the study consisting of 612 abdominal hysterectomies and 95 vaginal hysterectomies. Fibroids (47.6%) and uterovaginal prolapse (13.4%) formed the main indications for surgery. The initial preoperative diagnosis was accurate in 82.8% of cases. A different pathology from that initially suspected was noted in 118 cases. The overall complication rate was 7.9% but vaginal hysterectomies carried a statistically higher complication rate compared to abdominal hysterectomies. Urinary tract infection was significant in vaginal hysterectomies. Blood transfusion was required in 25.0% of abdominal and 6.3% of vaginal hysterectomies. There were no laparoscopic hysterectomies or mortality in this series.
Comment in: Soh EB, Ng KB. A survey of hysterectomy patterns in Malaysia. Med J Malaysia. 1999 Mar;54(1):152-4; Teoh TG. Hysterectomies in Malaysia: why are we left behind? Med J Malaysia. 1999 Mar;54(1):151-2

Matched MeSH terms: Blood Transfusion
Fulltext Bilateral internal carotid artery hypotrophy in malignant osteopetrosis

Ramli N, Rahmat K, Tan GP

Singapore Med J, 2008 Jul;49(7):e175-7.
PMID: 18695851

Malignant osteopetrosis is associated with petrous carotid canal and internal carotid artery stenosis in the skull base. We present a four-year-old boy with malignant osteopetrosis who developed right frontal lobe infarction as a result of bilateral internal carotid artery hypotrophy.

Matched MeSH terms: Blood Transfusion
Fulltext Seroepidemiology of toxoplasmosis in renal patients

Nissapatorn V, Leong TH, Lee R, Init-Ithoi, Ibrahim J, Yen TS

Southeast Asian J. Trop. Med. Public Health, 2011 Mar;42(2):237-47.
PMID: 21710842

Toxoplasmosis is an important parasitic disease in immunosuppressed patients. This prospective study was conducted to determine the seroprevalence, associated risk factors and the incidence of clinically confirmed toxoplasmosis among renal patients at the University of Malaya Medical Center, Kuala Lumpur, Malaysia. We interviewed 247 renal patients, each of whom answered an epidemiological questionnaire, and collected blood samples for measurement of anti-Toxoplasma IgG and IgM antibodies by ELISA. Overall seroprevalence of latent toxoplasmosis was observed in 126 (51%) renal patients. Race (Malays), marital status (married) and primary level of education, were all factors associated with a greater chance of Toxoplasma infection. A case of clinically confirned toxoplasmosis was diagnosed in a renal transplant recipient as a result of immunosuppression. Based on the findings obtained, this preliminary study shows a high prevalence of latent toxoplasmosis in renal patients. Risk factors may have significantly contributed to Toxoplasma acquisition in these patients. We recommend further studies be carried out to monitor for trends in toxoplasmosis among immunosuppressed patients.

Matched MeSH terms: Blood Transfusion/adverse effects
Fulltext Skeletal, dentoalveolar, and soft tissue cephalometric measurements of Malay transfusion-dependent thalassaemia patients

Toman HA, Nasir A, Hassan R, Hassan R

Eur J Orthod, 2011 Dec;33(6):700-4.
PMID: 21282284 DOI: 10.1093/ejo/cjq147

Thalassaemia is a public health problem in Malaysia. It is known to cause skeletal deformity. The purpose of this study was to compare the skeletal, dentoalveolar, and soft tissue features of Malay transfusion-dependent thalassaemia (TDT) patients with a Malay control group. Lateral cephalometric radiographs of 30 Malay (14 males and 16 females aged 6.4-21.8 years) TDT patients and 60 normal Malays matched for chronological age and gender were analysed and compared using an independent t-test. The TDT group showed a similar sagittal relationship to the control group but with a significantly increased (P < 0.01) mandibular plane inclination. They also showed a significantly shorter (P ≤ 0.001) mandibular body, ramus length, and posterior face height and consequently a smaller ratio of posterior to anterior face height (P < 0.01). The upper and lower lips were significantly procumbent (P < 0.001) in the TDT group together with a significantly smaller nasolabial angle (P < 0.05). Dentoalveolar measurements showed less proclined maxillary teeth in the TDT group compared with the controls (P < 0.05). The cephalometric features of Malay TDT patients were characterized by a mild Class II skeletal pattern, prominent vertical growth direction of the mandible, and protruded upper and lower lips.

Matched MeSH terms: Blood Transfusion*
Fulltext Major surgery in an osteosarcoma patient refusing blood transfusion: case report

Dhanoa A, Singh VA, Shanmugam R, Rajendram R

World J Surg Oncol, 2010;8:96.
PMID: 21059231 DOI: 10.1186/1477-7819-8-96

We describe an unusual case of osteosarcoma in a Jehovah's Witness patient who underwent chemotherapy and major surgery without the need for blood transfusion. This 16-year-old girl presented with osteosarcoma of the right proximal tibia requiring proximal tibia resection, followed by endoprosthesis replacement. She was successfully treated with neoadjuvant chemotherapy and surgery with the support of haematinics, granulocyte colony-stimulating factor, recombinant erythropoietin and intraoperative normovolaemic haemodilution. This case illustrates the importance of maintaining effective, open communication and exploring acceptable therapeutic alternative in the management of these patients, whilst still respecting their beliefs.

Matched MeSH terms: Blood Transfusion/psychology*
Efficiency of blood usage for elective surgery in the University Hospital Kuala Lumpur

Lim EJ, Lopez CG, Veera SN, Menaka N, Aminah A

Malays J Pathol, 1996 Dec;18(2):107-12.
PMID: 10879231

Provision of quality care, service and blood products to patients while containing costs and the amount of blood used should be the aim of every blood bank. Therefore a prospective audit was carried out over three months to determine how efficiently blood was being used in elective surgery in the University Hospital, Kuala Lumpur. Every case with blood crossmatched was monitored to determine the amount transfused and the posttransfusion haemoglobin level. Overcrossmatching of varying degrees was noted in almost all surgical procedures and overtransfusion in 45.5% of patients transfused. The rate of case postponement was 18.1%. These indicate inefficient utilization of blood and other resources. The transfusion index (TI) and range of units transfused were calculated for each procedure. They can be used as indicators of blood requirement and potential severity of hemorrhage. Suggestions to improve efficiency of blood utilization include the introduction and ongoing monitoring of guidelines on crossmatching and transfusion based on the data obtained here, by the hospital blood transfusion committee; the "group, screen and hold" practice for surgical procedures with high crossmatch transfusion ratios, low transfusion indices and a small range of units transfused could also be adopted.

Matched MeSH terms: Blood Transfusion/utilization*
Perioperative Outcome of Single Stage Posterior Spinal Fusion for Severe Adolescent Idiopathic Scoliosis (AIS) (Cobb Angle ≥90°): The Role of a Dual Attending Surgeon Strategy

Kwan MK, Chiu CK, Hasan MS, Tan SH, Loh LH, Yeo KS, et al.

Spine (Phila Pa 1976), 2019 03 15;44(6):E348-E356.
PMID: 30130336 DOI: 10.1097/BRS.0000000000002848

STUDY DESIGN: Retrospective study.
OBJECTIVE: To evaluate the perioperative outcome of dual attending surgeon strategy for severe adolescent idiopathic scoliosis (AIS) patients with Cobb angle more than or equal to 90°.
SUMMARY OF BACKGROUND DATA: The overall complication rate for AIS remains significant and is higher in severe scoliosis. Various operative strategies had been reported for severe scoliosis. However the role of dual attending surgeon strategy in improving the perioperative outcome in severe scoliosis has not been investigated.
METHODS: The patients were stratified into two groups, Cobb angles 90° to 100° (Group 1) and more than 100° (Group 2). Demographic, intraoperative, preoperative, and postoperative day 2 data were collected. The main outcome measures were intraoperative blood loss, use of allogeneic blood transfusion, operative time, duration of hospital stay postsurgery, and documentation of any perioperative complications.
RESULTS: Eighty-five patients were recruited. The mean age for the whole cohort was 16.2 ± 5.2 years old. The mean age of Group 1 was 16.7 ± 5.7 and Group 2 was 15.6 ± 4.8 years old. The majority of the patients in both groups were Lenke 2 curves with the average Cobb angle of 93.9 ± 3.0° in Group 1 and 114.2 ± 10.2° in Group 2. The average operative time was 198.5 ± 47.5 minutes with an average blood loss of 1699.5 ± 939.3 mL. The allogeneic blood transfusion rate was 17.6%. The average length of stay postoperation was 71.6 ± 22.5 hours. When comparing the patients between Group 1 and Group 2, the operating time, total blood loss, allogeneic transfusion rate showed significant intergroup differences. Five complications were documented (one intraoperative seizure, one massive blood loss, one intraoperative loss of somatosensory evoked potential (SSEP) signal, and two superficial wound breakdown).
CONCLUSION: Dual attending surgeon strategy in severe AIS more than or equal to 90° demonstrated an average operative time of 199 minutes, intraoperative blood loss of 1.7 L, postoperative hospital stay of 71.6 hours, and a complication rate of 5.9% (5/85 patients). Curves with Cobb angle more than 100° lead to longer operating time, greater blood loss, and allogeneic transfusion rate.
LEVEL OF EVIDENCE: 4.

Matched MeSH terms: Blood Transfusion/trends
Fulltext Malaysian child infected with Plasmodium vivax via blood transfusion: a case report

Anthony CN, Lau YL, Sum JS, Fong MY, Ariffin H, Zaw WL, et al.

Malar J, 2013;12:308.
PMID: 24007496 DOI: 10.1186/1475-2875-12-308

Malaria may be a serious complication of blood transfusion due to the asymptomatic persistence of parasites in some donors. This case report highlights the transfusion-transmitted malaria of Plasmodium vivax in a child diagnosed with germ cell tumour. This child had received blood transfusion from three donors and a week later started developing malaria like symptoms. Nested PCR and sequencing confirmed that one of the three donors was infected with P. vivax and this was transmitted to the 12-year-old child. To the best of the authors' knowledge, this is the first reported transfusion-transmitted malaria case in Malaysia.

Matched MeSH terms: Blood Transfusion/adverse effects*
Evaluation of serological transfusion-transmitted viral diseases and mutliplex nucleic acid testing in malaysian blood donors

Yaseen SG, Ahmed SA, Johan MF, Kiron R, Daher AM

Transfus Apher Sci, 2013 Dec;49(3):647-51.
PMID: 23890575 DOI: 10.1016/j.transci.2013.07.003

Transmission of infectious diseases is a recognized complication of blood transfusion and blood products. Nucleic acid testing (NAT) may contribute to improved efficiency of blood screening and thereby increase the safety margin for transfused blood.

Matched MeSH terms: Blood Transfusion/methods*
Fulltext Audit of perioperative blood transfusion

Choy YC, Lim WL, Ng SH

Med J Malaysia, 2007 Oct;62(4):299-302.
PMID: 18551933 MyJurnal

The main goal of perioperative transfusion is to reduce the morbidity and mortality associated with inadequate delivery of oxygen to the tissues during surgery. In this audit, the primary trigger for transfusion was clinical anaemia assessed by examination of a patient's conjunctiva [40.7%] followed by estimation of blood loss of greater 20% of total blood volume [29.3%]. Haemoglobin estimation in the operation theater was not done in 45.9% of studied patients and only 7.8% patients had transfusion based on this criteria. A common practice is to transfuse blood for hypovolaemia. This was the indication for blood transfusion in 96 patients (7.8%). Inappropriate use of blood in this way has led to wastage of a valuable resource and exposed patients to potential risks of unwanted side effects. Analysis of haemoglobin estimation at recovery room showed 32% of patient with co-morbidities had Hb > 10 gm% while 65% and 29.5% of patients without co-morbidities had Hb > 8 gm% and 10 gm% respectively. This reflects the practice of anaesthetists in maintaining a target of Hb of 10 gm% for both groups of patients while a target of 8 gm% is still relatively safe for patients with good cardiovascular reserves. This has resulted in signifant use of homologous blood which will certainly burden the blood bank and increase the cost of healthcare.

Matched MeSH terms: Blood Transfusion*
Intralesional autologous blood injection compared to corticosteroid injection for treatment of chronic plantar fasciitis. A prospective, randomized, controlled trial

Lee TG, Ahmad TS

Foot Ankle Int, 2007 Sep;28(9):984-90.
PMID: 17880872

The response of chronic plantar fasciitis to any treatment is unpredictable. Autologous blood might provide cellular and humoral mediators to induce healing in areas of degeneration, the underlying pathology in plantar fasciitis. This study compared the efficacy of intralesional autologous blood with corticosteroid injection for plantar fasciitis present for more than 6 weeks.

Matched MeSH terms: Blood Transfusion, Autologous/methods*
Bone-related complications of transfusion-dependent beta thalassemia among children and adolescents

Mirhosseini NZ, Shahar S, Ghayour-Mobarhan M, Banihashem A, Kamaruddin NA, Hatef MR, et al.

J. Bone Miner. Metab., 2013 Jul;31(4):468-76.
PMID: 23475127 DOI: 10.1007/s00774-013-0433-1

Thalassemia and the blood transfusion complications associated with it predispose children to poor bone health. This study was conducted to determine the prevalence of bone-related abnormalities and identify the bone health predictors within this population. One hundred and forty transfusion-dependent beta thalassemic subjects 8-18 years old in Mashhad, Iran, participated in this cross-sectional study. Anthropometric measures, dietary intake, bone-related biomarkers and bone densitometry, were assessed. The incidence of underweight and short stature was 33.6 and 41.4 %, respectively, which were indicators of malnutrition among thalassemic subjects in this study. Low bone density was detected in the lumbar spine and femoral region in 82 and 52 % of subjects, respectively. Hypocalcemia and hypophosphatemia were seen in 22 and 18.2 %, whilst vitamin D deficiency was present in more than 85 % of thalassemic children and adolescents. The relationships between weight, height and other anthropometric indices, serum calcium and bone markers, intake of macronutrients, zinc and vitamin E with bone mineral density (BMD) and bone mineral content (BMC) in the lumbar spine and femoral area were positively related, indicating that better nutritional status were associated with higher BMD and BMC values. Puberty, gender and serum osteocalcin were negative predictors for BMD and BMC values, whereas age, weight and height were the positive predictors. High incidence of low bone density and deficit in other aspects of bone health among thalassemia patients makes routine bone health assessment necessary for this vulnerable group. Considering influencing factors, dietary counseling and preventive supplementation therapy for this high risk group of children and adolescents may be necessary, although this should be assessed by intervention studies.

Matched MeSH terms: Blood Transfusion/adverse effects*

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