Analysis of economic efficiency of iron deficiency anemia therapy in patients with malignant tumors

Introduction. Correction of iron deficiency anemia in patients with malignant neoplasms is an important aspect affecting the quality of life and the effectiveness of special treatments. At the same time, the therapy of comorbid conditions significantly increases the cost of treating cancer patients.The aim of the study was to conduct a comparative pharmacoeconomic analysis of the two most common methods for correcting iron deficiency anemia in cancer patients: transfusion of erythrocyte suspension and intravenous iron preparations using iron carboxymaltose as an example.Materials and methods. An observational, analytical, cohort study was carried out, which included 120 cancer patients. The patients underwent laboratory examination. The tests were assessed: a general blood test with an assessment of the morphological characteristics of erythrocytes, serum iron, ferritin, CRP, total protein. An analysis of the costs of iron deficiency anemia therapy was carried out, taking into account the procurement cost of drugs.Results. It is economically more profitable to use intravenous iron preparations in comparison with transfusion of erythrocyte suspension for the treatment of iron deficiency anemia in patients with malignant neoplasms. The cost of correcting iron deficiency anemia per patient was: when treated with carboxymaltosate iron (Ferinject): 7943.96 rubles, with transfusion of erythrocyte suspension: 16856.40 rubles.Conclusion. In the treatment of anemia in patients with malignant neoplasms with blood preparations (erythrocyte suspension), an improvement in hematological parameters is noted earlier and to a greater extent than with the use of iron preparation carboxymaltozate («Ferinject»). Nevertheless, the duration of the clinical effect when using erythrocyte suspension is lower than that of a parenteral iron preparation.

Analysis of the contents of consultations requested by the emergency department

Background and objectives: Every year several thousand patients attend the hospital emergency department (ED). The aim of the present study was to evaluate the content of the consultations requested from the emergency department. Methods: The patients who had presented to the adult emergency department between January 1, 2020 and January 31, 2020, and who had undergone consultation by at least one clinic were included in the study. Age, gender, the number of consultation required at the same admission, the clinic from which the consultation sought, time required to respond to the request and the outcomes of the consultations were analyzed. Results: The total number of emergency department presentations was 8930 patients and at least one consultation had been requested for 6.64% (n = 593) patients. The mean duration of answering the consultation was 85.76 ± 90.33 minutes. Consultations were requested from the cardiology most frequently (n = 188, 19%), followed by the pulmonology department (n = 181, 18.3%). Discharge was recommended with prescription in 235 (39.6%) consultations. Internal medicine was the clinic, which recommended treatment at the emergency room most frequently (n = 45, 22.4%) and the most commonly recommended treatment was erythrocyte suspension replacement (n = 7). The clinic that demanded additional tests most commonly was determined to be the pulmonology department (n = 41, 22.9%) and arterial blood gases analysis was the most commonly demanded test (n = 16). Conclusion: In our study, the rate of consultations requested was seen to be lower and the rate of cases that required hospitalization was seen to be higher. The duration of answering consultations was found to be longer than desired and institutional protocols should be developed for shortening this duration. Ibrahim Med. Coll. J. 2021; 15(1): 9-15

The cost of one unit blood transfusion components and cost-effectiveness analysis results of transfusion improvement program

Background: This study aims to analyze the cost of the entire transfusion process in Turkey including evaluation of the cost of transfusion from the perspective of hospital management and determination of savings achieved with the transfusion improvement program. Methods: Invoices, labor, material costs were calculated with micro-costing method, while general production expenses were calculated with gross costing method between January 2018 and December 2019. Unit costs for each blood product were calculated separately by collecting unit acquisition costs, material costs, labor costs, and general production expenses and, then, distributed into six different blood products as follows: erythrocyte suspension, fresh frozen plasma, pooled platelet, apheresis platelet, cryoprecipitate, fresh whole blood. The total costs for 2018 and 2019 were calculated and the savings achieved were estimated. The Turkish Lira was converted into the United States Dollar ($) currency using the purchasing power parity. Results: In 2018/2019, the blood component transfusion cost was $240.90/251.18 for erythrocyte suspension, $120.00/128.67 for fresh frozen plasma, $313.50/322.19 for pooled platelet, $314.24/325.73 for apheresis platelet, $104.95/113.99 for cryoprecipitate, and $189.91/209.09 for fresh whole blood. The total transfusion cost was $6,224,208.33 in 2108 and $5,308,148.43 in 2019. As a result of the transfusion improvement program launched in 2019, the amount of blood components decreased by 23.24%, compared to the previous year, and a saving of $916,059.9 was achieved. Conclusion: The transfusion is a burden for both the hospital management systems and the country's economy. To accurately calculate and manage this economic burden is important for sustainable healthcare services.

PHTHALATES RELEASED AFTER ERYTHROCYTE SUSPENSION: DO THEY POSE A RISK?

It is commonly known that stored blood and blood products are heated before transfusion in order to prevent hypothermia, which leads to increased di-(2-ethylhexyl) phthalate content leaching into the blood and blood products and thereby causes greater conversion of di-(2-ethylhexyl) phthalate to mono (2-ethylhexyl) phthalate. However, there has been no study in the literature reporting on the amount of toxic phthalates in blood following the erythrocyte suspension transfused via warming. In this study, we aimed to investigate the di-(2-ethylhexyl) phthalate and mono (2-ethylhexyl) phthalate content in blood following the ES transfusions administered by di-(2-ethylhexyl) phthalate -containing and di-(2-ethylhexyl) phthalate -free infusion sets. The study included 30 patients that were randomly divided into 2 groups with 15 patients each: group I underwent erythrocyte suspension transfusion via di-(2-ethylhexyl) phthalate -containing infusion sets warmed with blood-fluid warmers and group II underwent erythrocyte suspension transfusion via di-(2-ethylhexyl) phthalate-free infusion sets warmed with blood-fluid warmers. Di-(2-ethylhexyl) phthalate and mono (2-ethylhexyl) phthalate levels were measured both before and after transfusion. Di-(2-ethylhexyl) phthalate-free infusion sets led to no increase in the phthalate content, whereas di-(2-ethylhexyl) phthalate-containing infusion sets significantly increased the di-(2-ethylhexyl) phthalate and mono (2-ethylhexyl) phthalate levels, where the di-(2-ethylhexyl) phthalate level increased almost four times (p=0.001). Di-(2-ethylhexyl) phthalate-containing products lead to toxicity. Therefore, using di-(2-ethylhexyl) phthalate-free products may prevent toxicity in patients undergoing erythrocyte suspension transfusion.

Implementation of the method of acidic erythrograms to reveal the membranotropic effect of biologically active peptides

The method of acidic erythrograms was used to study the membranotropic effect of biologically active peptides (BAP). The air exposure of erythrocyte suspension in isotonic sodium chloride solution caused a decrease in their resistance to acid hemolysis: the time of hemolysis decreased, the integral indicator of erythrocyte resistance decreased too. The air exposure of erythrocyte suspension with the BAP solutions (10-8M) changed the hemolytic resistance of erythrocytes. It was found out that a non-opiate analogue of leu-enkephalin (NALE – Phe-D-Ala-Glu-Phe-Leu-Arg), Selank (Thr-Lys-Pro-Arg-ProGly-Pro) and Semax (Met-Glu -His-Phe-Pro-Gly-Pro) increase the resistance of erythrocyte membranes to acid hemolysis, and the Arg-Gly-Arg-Pro-Gly-Pro peptide decreases the resistance of erythrocyte membranes to acid hemolysis. Membranotropic action can determine the nonspecific effects of BAP and the range of their clinical use. Acidic erythrograms can be used as a screening method for the selection of BAP with membranotropic effects.

Homogeneous Deformation of Native Erythrocytes During Long-Term Storage

Purpose of the study — to evaluate biomechanical regularities of deep deformation of native erythrocytes’ membranes during long-term (up to 32 days) storage of erythrocyte suspension.Materials and methods. The method for addressing the said problem was atomic-force spectroscopy. The measured value was hHz comprizing the depth to which the probe immersion process was described by interaction with a homogeneous medium. Empirical and theoretical dependence of the interaction force F (nN) on the probe immersion depth h (nm) — F (h) were obtained. Bar charts of relative frequency density of Young’s modulus E were built.Results. Modulus E changed from 9.3±3.2 kPa — for 3 days of storage, to 22.7±8.7 kPa — for 32 days. Coefficients of skewness were 0.52±0.04 (for day 3) and 0.82±0.09 (for day 32 d), hHz value remaining constant.Conclusion. Progressively as erythrocyte suspension was stored, erythrocyte membranes to the depth of 700 nm deflected homogeneously in spite of 2.4-fold increase of Young’s modulus.