Characteristics and Outcomes of Patients Receiving Massive Transfusions at a Tertiary Care Centre

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4412-4412
Author(s):  
Sita Bhella ◽  
Sandro Rizoli ◽  
Jeannie Callum
Keyword(s):  
Overall Survival ◽  
Massive Transfusion ◽  
Tertiary Care ◽  
Health Sciences ◽  
Neurological Function ◽  
Blood Products ◽  
Women's College ◽  
College Hospital ◽  
Sunnybrook Health ◽  
Number Of Patients

Abstract Abstract 4412 Purpose: To determine the characteristics and outcomes of patients who had been massively transfused at a university affiliated trauma centre. Method: Consecutive patients who received ≥ 10 RBC units in ≤ 24 hours at Sunnybrook Health Sciences Centre and Women's College Hospital from January 2007 to December 2008 were identified. Demographic and outcome data were extracted through the blood bank database and retrospective chart analysis. Result: 6,326 patients were transfused a total of 19,845 RBC units in 2007 and 2008 at Sunnybrook Health Sciences Centre and Women's College Hospital. 134 consecutive massive transfusions among 131 patients were identified. Patients who were massively transfused received a total of 2,284 RBC units, represented 2.1% of the total number of patients transfused and used 11.5% of the total RBC units transfused. Their median age was 66 years and 63% were men. 50% survived to discharge. Of those who survived, 50% were discharged home, 41 % were discharged to a rehabilitation facility, and 9% was discharged to another acute care facility. A single patient had poor neurological function and was ventilator dependent at discharge. The median number of units transfused in ≤ 24 hrs among patients who received massive transfusions was 18.5 RBC units, 2 pools of platelets, 8 FFP and 8 cryoprecipitate. At our institution, 1 pool of platelet equals 4 individual platelets or a single apheresis platelet. Recombinant Factor 7a was utilized in 19% of the massive transfusions. Median length of stay in hospital was 17 days. Median time to death (TTD) from the massive transfusion event was 1 day. Overall survival (OS) among patients who were transfused 10–19 units (n=107), 20–29 (n=16), ≥30 (n=11) RBC units in ≤ 24 hours were: 56%, 31%, and 55% respectively. Indications and overall survival for massive transfusion were: trauma (49%, OS 51%, TTD 0 days), cardiac surgery (22%, OS 41%, TTD 12 days), oncologic surgery (12%, OS 63%, TTD 12 days), vascular surgery (6%,OS 50%, TTD 8.5 days), GI bleed (3%, OS 50%, TTD 18 days) and other (8%, OS 55%, TTD 19 days). Conclusion: Patients who have been massively transfused (≥10 RBC units in ≤ 24 hours) use a disproportionate amount of blood products. Trauma, cardiac and oncologic surgeries are the most common indications for massive transfusion at Sunnybrook Health Sciences Centre and Women's College Hospital. All causes of massive transfusion had similar mortality of approximately 50% and the majority of the survivors were discharged home or to rehabilitation with preserved neurological function. Transfusions of ≥ 30 RBC units in 24 hours were not associated with worse survival outcomes. A noticeable difference between the groups was in trauma where death occurred within hours of admission, while the majority of deaths for other causes occurred between 8 and 18 days later. These findings suggest that bleeding may have been directly responsible for most trauma deaths, while complications related to bleeding may have caused the late deaths observed in the other groups. Measures for defining medical futility, other than volume of blood products transfused, need to be sought. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Clinical spectrum of facial hypermelanosis: a descriptive study from a tertiary care centre

2020 ◽  
Vol 6 (2) ◽  
pp. 212
Author(s):  
Mohammed Thoyyib ◽  
Roshni Menon ◽  
Brinda G. David
Keyword(s):  
Tertiary Care ◽  
Clinical History ◽  
Climatic Conditions ◽  
Research Centre ◽  
Tertiary Care Centre ◽  
College Hospital ◽  
Pigmentary Disorders ◽  
Number Of Patients ◽  
The Face ◽  
Detailed Clinical History

<p class="abstract"><strong>Background:</strong> Facial melanosis (FM) which refers to brown, black or blue pigmentation over the face is a common cosmetic concern in Indian patients. This increased incidence could be due to remarkable diversity of Indian ethinic population. Pigmentary disorders of the face are a great cosmetic and psychological concern for the patients.</p><p class="abstract"><strong>Methods:</strong> This is an extensive descriptive clinico epidemiological study comprising of 1024 patients, conducted at Sri Venkateshwara Medical College Hospital and Research Centre, Puducherry, for a period of one and a half years. A detailed clinical history and examination was done, and all the clinical photographs and data were recorded. Necessary investigations like skin biopsy and patch testing was done wherever required.<strong></strong></p><p class="abstract"><strong>Results:</strong> The maximum number of patients belong to the age group of 21-35 years with a female predominance (67.2%). Among patients of FM, post inflammatory pigmentation (35.3%) was the most common comprising of 362 patients, followed by melasma (17.2%), periorbital melanosis (15.7%), seborrheic melanosis (7.5%) followed by other causes.</p><p><strong>Conclusions:</strong> FM is common in Indian skin, several of which have overlapping features, and some have defined clinical classification. Additionally, climatic conditions, cosmetic usage and social parameters predispose to the increased incidence of FM.</p>

A Cost-Outcome Description of the Septic Work-Up for Bacterial Infection in Neonates in a Tertiary Care Hospital

1995 ◽  
Vol 11 (1) ◽  
pp. 11-25 ◽  
Author(s):  
Roger E. Thomas ◽  
Philip Baker
Keyword(s):  
Blood Cell ◽  
Neonatal Sepsis ◽  
Average Cost ◽  
Tertiary Care Hospital ◽  
Tertiary Care ◽  
Care Hospital ◽  
Women's College ◽  
Blood Cell Count ◽  
College Hospital ◽  
Work Up

AbstractAnalysis of the septic work-up of 194 neonates at Women's College Hospital, Toronto, showed that the only antepartum condition predicting neonatal sepsis was the mother being on antibiotics. The only postnatal condition predicting sepsis was a maternal postpartum white blood cell count over 11,000. The average cost for tests for a septic work-up in these 194 mother-neonate pairs was $71.48 (Canadian dollars), and the average cost of tests to find a septic case was $1,066.77.

scholarly journals Supra-massive transfusion and interdisciplinary approach to cesarean hysterectomy due to complex placenta percreta: Case report

2021 ◽  
Vol 9 ◽  
pp. 2050313X2110100
Author(s):  
Efrain Riveros-Perez ◽  
Maria Gabriela Sanchez ◽  
Nadine Odo ◽  
Mrinal Shukla ◽  
Bunya Rungruang
Keyword(s):  
Massive Transfusion ◽  
Care Center ◽  
Tertiary Care ◽  
Interdisciplinary Approach ◽  
Uterine Wall ◽  
Placenta Percreta ◽  
Blood Products ◽  
Successful Management ◽  
Perioperative Morbidity ◽  
Risk Of Death

Placenta accreta spectrum encompasses a group of conditions of abnormal placental infiltration of the uterine wall and surrounding tissues. It is associated with significant blood loss, perioperative morbidity, and risk of death. A coordinated interdisciplinary approach to these complex cases and early resuscitation with blood products are critical factors in the successful management of patients affected by this disease. We describe the successful management of a patient with placenta percreta who required supra-massive transfusion of blood products and interventions by different specialized teams in a tertiary care center.

scholarly journals Spectrum of Neurological Disorders: Experience in Specialized Outpatient Clinic in Bangladesh

1970 ◽  
Vol 13 (1) ◽  
pp. 39-42
Author(s):  
RN Chowdhury ◽  
ATM H Hasan ◽  
KM Rahman ◽  
M Shyfullah ◽  
SR Deb ◽  
...  
Keyword(s):  
Outpatient Clinic ◽  
Neurological Disorders ◽  
Neurological Diseases ◽  
Tertiary Care ◽  
College Hospital ◽  
Care Level ◽  
Neurologic Disorder ◽  
Medical College ◽  
Number Of Patients ◽  
Neurology Clinic

Objective: To examine the burden of neurologic disorder as encountered in a specialized neurology clinic at tertiary care level. Methods: This retrospective study was carried out in specialized neurology outpatient clinic of Dhaka Medical College Hospital from July 2010 to June 2011, which included 3173 patients. Data were collected through a predesigned questionnaire from the hospital database kept at the clinic. Result: Among all the patients attending outpatient clinic, 88.7% had 44 types of neurological disorders. Distribution of disease was similar in all age group from 21-30 years to 51-60 years. Stroke (28.2%) and Headache (24.7%) were two most common neurologic disease, where headache was prevalent among female aged less than 30 years and stroke in male of >40 years. Epilepsy, peripheral neuropathy, Parkinson’s disease, pseudo vertigo were also present in a considerable number of patients. Patients with peptic ulcer (3.02%), anxiety neurosis (2.6%) and other non neurological disease were also given consultation in the clinic. Conclusion: Neurological diseases are not uncommon. Different diseases predominate in different age and sexes. Knowing pattern of disease distribution in community will help managing them properly. DOI: http://dx.doi.org/10.3329/jom.v13i1.10045 JOM 2012; 13(1): 39-42

scholarly journals Clinical, Imaging, and Endoscopic Profile of Patients with Abdominal Tuberculosis

2019 ◽  
Vol 10 (02) ◽  
pp. 112-117
Author(s):  
Syed Shafiq
Keyword(s):  
Complete Blood Count ◽  
Care Center ◽  
Abdominal Mass ◽  
Tertiary Care ◽  
Abdominal Tuberculosis ◽  
Common Finding ◽  
College Hospital ◽  
Clinical Imaging ◽  
Antituberculosis Treatment ◽  
Number Of Patients

Abstract Aims: The aim is to study the clinical, imaging, and endoscopic profile of patients with abdominal tuberculosis (TB) in a tertiary care center. Subjects and Methods: This was a prospective observational study conducted at Meenakshi Medical College Hospital, Kancheepuram, over a 3-year period, from March 2011 to February 2014. A total of 76 patients were diagnosed with abdominal TB based on their clinical, pathological, endoscopic, and radiological features. A meticulous history and physical examination with complete blood count, human immunodeficiency virus (HIV) status, chest X-ray, ultrasound abdomen, upper endoscopy, and colonoscopy was performed. Barium study, ascitic fluid analysis, and contrast-enhanced computed tomography of the abdomen and pelvis with peritoneal biopsies where need be were also obtained. All the patients received antituberculosis treatment (ATT) under close surveillance and monitoring. Results: The total number of patients enrolled in our study was 76 with age ranging from 18 to 75 years; 40 were male and 36 were female. There was a significant overlap of symptoms, and most of the patients presented with a multitude of complaints. Abdominal pain was the most common complaint noted in 70 patients, followed by loss of appetite and weight loss in 52, fever in 48, constipation in 28, abdominal distention in 14, and diarrhea in 6 patients. Two patients presented with acute intestinal obstruction requiring emergency surgical intervention. Fever was the most common finding followed by anemia, ascites, abdominal tenderness, and a palpable abdominal mass. A history of pulmonary Koch's was elicited in 28 patients, and 17 had defaulted on treatment. All the patients enrolled in our study received ATT although six were lost to follow-up. Conclusions: Abdominal TB can present with a myriad of signs and symptoms, and early diagnosis and treatment are the keys for an effective cure and for reducing the morbidity and mortality from this chronic granulomatous disease.

Scenario of General Anesthesia for Cesarean Section in Rural Tertiary Care Center in High Altitude Karnali Academy of Health Sciences

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Ramesh Bhattarai ◽  
Rajiv Shah ◽  
Sita Dhakal ◽  
Pragya Malla ◽  
Srijana Sapkota
Keyword(s):  
Cesarean Section ◽  
General Anesthesia ◽  
High Altitude ◽  
Spinal Anesthesia ◽  
Neonatal Outcome ◽  
Care Center ◽  
Tertiary Care ◽  
Health Sciences ◽  
Tertiary Care Center ◽  
Cord Prolapse

Background: General anesthesia for cesarean section is being less popular for cesarean section in present days but sometime general anesthesia is inevitable. The aim of the study is to assess the trends of general anesthesia, indications, clinical outcome in mother and fetus in high altitude setting of tertiary care center of Nepal. Methods: We conducted descriptive cross-sectional study all cases of cesarean section in Karnali Academy of health Sciences (KAHS) located at high altitude over three years period   in our institute. Data were retrieved from the hospital records during three fiscal year (Jan 1st 2017 to Jan Dec 31st 2019). The record of all the patients who underwent cesarean section under general anesthesia was reviewed for demographic details, indication of general anesthesia, trends for general and spinal anesthesia and maternal and neonatal outcome. Results: Out of total deliveries 2175, 309 (14.2%) cases account for cesarean section. Among them, 52 (17%) required general anesthesia . Eclampsia 19(36%) remain the major indication for General Anesthesia in cesarean section followed by failure of spinal anesthesia number 14 (26%) , cord prolapse six (12%), antepartam haemorrhage five (10%), spinal site infection four (8%), Khiphoscoliosis two(4%), Patients request  two (4%). Use for general anesthesia technique was consistent for three years with slow rise in use of spinal anesthesia . There was no any anesthesia related maternal mortality and nine intraoperative neonatal   Conclusions:  General anesthesia practices are consistently required in rural high-altitude setup. Eclampsia is the commonest indication followed by failure of spinal anesthesia and cord prolapse. Neonatal outcome is still not good.  

Causes of Epilepsy in Elderly Patients Presenting in a Tertiary Care Hospital of Karachi

2020 ◽  
Keyword(s):  
Elderly Patients ◽  
Cerebrovascular Disease ◽  
Neurodegenerative Disorder ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Traumatic Head Injury ◽  
Keywords Epilepsy ◽  
College Hospital ◽  
Cross Sectional

Background: Epilepsy is fairly a frequent occurrence in the elderly. It is commonly diagnosed after the episode of two or more unprovoked seizures. Unprovoked seizures in elderly are recurrent rather than younger individuals. This study was designed to estimate the concrete burden of frequent causes of epilepsy. Methods: A descriptive cross-sectional study with a total of 153 patients diagnosed case of epilepsy were included in this study at Jinnah Medical College Hospital from February 2018-August 2018. Mean was calculated for age, duration of disease of the patients. Causes of epilepsy, gender, and education was calculated and presented as percentages. Electrolyte readings were taken i.e., Sodium, Calcium and Magnesium levels and imaging was planned to rule out stroke, primary neurodegenerative disorders and tumors. Post stratification Chi square test was applied and p-value less than or equal to 0.05 was considered significant. Results: The mean age of the patients was 63.91±5.68 years and mean duration of the disease was 4.61± 1.07 months. The common causes of epilepsy were found to be cerebrovascular disease 56.9%, cryptogenic 54.2%, neurodegenerative disorder 20.3%, traumatic head injury 11.8%, metabolic abnormalities or electrolyte disturbances 10.5% and brain tumor 7.8%. Conclusion: Elderly patients with first seizure should present to a facility designed in a way that neurologist, cardiologist, rehabilitation and geriatrics work together to identify and treat the condition in a better way. Keywords: Epilepsy; Seizures; Cerebrovascular Disease; Neurodegenerative Disorder.

scholarly journals Peripartum hysterectomy: a five year review at a tertiary care centre

2017 ◽  
Vol 6 (8) ◽  
pp. 3590
Author(s):  
Deepak A. V. ◽  
K. J. Jacob ◽  
Sumi P. Maria
Keyword(s):  
Tertiary Care ◽  
Case Series ◽  
Case Fatality ◽  
Tertiary Care Centre ◽  
Retrospective Case ◽  
College Hospital ◽  
Peripartum Hysterectomy ◽  
Medical College ◽  
Obstetric Haemorrhage ◽  
Suboptimal Care

Background: Peripartum hysterectomy is a life-saving procedure resorted to when conservative measures fail to control obstetric haemorrhage. Several predisposing factors, suboptimal care and lack of infrastructure may lead to this emergency procedure. We wanted to find out factors associated with peripartum hysterectomy and the adverse maternal outcomes at our centre.Methods: A retrospective case series analysis of 40 cases of peripartum hysterectomy performed over a period of 5 years from January 2010 to December 2014 at Government Medical College Hospital, Thrissur, Kerala was done.Results: The incidence of peripartum hysterectomy was 0.29%. The most common indication for peripartum hysterectomy was hysterectomy was uterine atony (50%). Thirty-five women (88%) were between 20 and 35 years. Most of the subjects were unbooked. There were two maternal deaths (case fatality rate of 5%) following peripartum hysterectomy during this period. All the subjects required blood transfusion.Conclusions: Prompt performance hysterectomy before the patient’s clinical condition deteriorates is the key to success. The incidence of adherent placenta is increasing, so every effort should be taken to reduce the caesarean section rates globally. 

scholarly journals T stage-dependent lymph node and distant metastasis and the accuracy of lymph node assessment in rectal cancer

2021 ◽  
Author(s):  
Henry Ptok ◽  
Frank Meyer ◽  
Roland S. Croner ◽  
Ingo Gastinger ◽  
Benjamin Garlipp
Keyword(s):  
Rectal Cancer ◽  
Overall Survival ◽  
Lymph Node ◽  
Lymph Nodes ◽  
False Negative ◽  
Cumulative Risk ◽  
Distant Metastases ◽  
Number Of Patients ◽  
Tumor Stages ◽  
The Impact

Summary Objective To analyze data obtained in a representative number of patients with primary rectal cancer with respect to lymph node diagnostics and related tumor stages. Methods In pT2-, pT3-, and pT4 rectal cancer lesions, the impact of investigated lymph nodes on the frequency of pN+ status, the cumulative risk of metachronous distant metastases, and overall survival was studied by means of a prospective multicenter observational study over a defined period of time. Results From 2000 to 2011, the proportion of surgical specimens with ≥ 12 investigated lymph nodes increased significantly, from 73.6% to 93.2% (p < 0.001; the number of investigated lymph nodes from 16.2 to 20.8; p < 0.001). Despite this, the percentage of pN+ rectal cancer lesions varied only non-significantly (39.9% to 45.9%; p = 0.130; median, 44.1%). For pT2-, pT3-, and pT4 rectal cancer lesions, there was an increasing proportion of pN+ findings correlating significantly with the number of investigated lymph nodes up to n = 12 investigated lymph nodes. Only in pT3 rectal cancer was there a significant increase in pN+ findings in case of > 12 lymph nodes (p = 0.001), but not in pT2 (p = 0.655) and pT4 cancer lesions (p = 0.256). For pT3pN0cM0 rectal cancer, the risk of metachronous distant metastases and overall survival did not depend on the number of investigated lymph nodes. Conclusion In rectal cancer, at least n = 12 lymph nodes are to be minimally investigated. The investigation of fewer lymph nodes is associated with a higher risk of false-negative pN0 findings. In particular, in pT3 rectal cancer, the investigation of more than 12 lymph nodes lowers the risk of false-negative pN0 findings. An upstaging effect by the investigation of a possibly maximal number of lymph nodes could not be detected.

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