Use of hyperbaric oxygenation as an adjunctive treatment for severe pernicious anaemia in a bloodless medicine patient

Severe anaemia in patients who cannot receive blood transfusion is an indication for the use of hyperbaric oxygen therapy (HBO). Most reports of the use of HBO for anaemia involve patients with acute blood loss. This report details a case of HBO used for a patient with severe pernicious anaemia. A 35-year-old Jehovah’s Witnesses believer presented to a hospital with fatigue, dyspnoea and haemoglobin of 26 g/L. She was diagnosed with pernicious anaemia. As she could not receive blood transfusion due to her religious beliefs, vitamin B12 supplementation and HBO were administered and resulted in significant improvement in her condition. The mechanisms of action of HBO, including increased systemic plasma oxygenation, can alleviate signs and symptoms of anaemia regardless of its aetiology. HBO administration can greatly enhance the plasma arterial oxygen content, leading to clinical improvement in patients with anaemia who cannot receive blood transfusion.

Using acute hypervolaemic haemodilution as blood conservation technique in a Jehovah’s witness patient undergoing an emergency transphenoidal surgery: a Sabah experience

Jehovah’s Witnesses (JW) is a branch of Christianity which was founded in 1872. However, their beliefs differ from other Christians in many ways. Majority of JW believe that it is against the teaching of God should they receive blood transfusion, while minority think receiving own blood or others is acceptable. These vast beliefs should always be respected by all medical practitioners to avoid medicolegal implications. The differing beliefs about blood transfusion is certainly a huge challenge to the surgeons and anesthesiologists, especially dealing with major surgeries. Thus, effective surgical and anaesthetic techniques are focused to minimise blood loss to avoid unnecessary blood transfusion. We report a JW patient who successfully underwent an emergency endoscopic transsphenoidal surgery secondary to pituitary apoplexy; highlighting our intraoperative acute hypervolaemic haemodilution technique to reduce blood loss.

Association between Allogeneic Blood Transfusion and Wound Infection after Total Hip or Knee Arthroplasty: A Retrospective Case-Control Study

Background: To assess using a retrospective case control study, whether patients undergoing primary, elective total hip or knee arthroplasty who receive blood transfusion have a higher rate of post-operative infection compared to those who do not.Materials and Methods: Data on elective primary total hip or knee arthroplasty patients, including patient characteristics, co-morbidities, type and duration of surgery, blood transfusion, deep and superficial infection was extracted from the Alberta Bone and Joint Health Institute (ABJHI). Logistic regression analysis was used to compare deep infection and superficial infection in blood-transfused and non-transfused cohorts.Results: Of the 27892 patients identified, 3098 (11.1%) received blood transfusion (TKA 9.7%; THA 13.1%). Overall, the rate of superficial infection (SI) was 0.5% and deep infection (DI) was 1.1%. The infection rates in the transfused cohort were SI 1.0% and DI 1.6%, and in the non-transfused cohort were SI 0.5% and DI 1.0%. The transfused cohort had an increased risk of superficial infection (adjusted odds ratio (OR) 1.9 [95% CI 1.2-2.9, p-value 0.005]) as well as deep infection (adjusted OR 1.6 [95% CI 1.1-2.2, p-value 0.008]).Conclusion: The odds of superficial and deep wound infection are significantly increased in primary, elective total hip and knee arthroplasty patients who receive blood transfusion compared to those who did not. This study can potentially help in reducing periprosthetic hip or knee infections.

PERBEDAAN REAKSI PEMBERIAN TRANSFUSI DARAH WHOOLE BLOOD (WB) DAN PACKED RED CELL (PRC) PADA PASIEN SECTIO CAESARE

<p>Transfusion reaction is the reaction of the recipient's body to blood donors, blood transfusion reactions can be mild to severe, and could be either fast, medium and slow. Hospital Dr. Achmad Darwis District Lima Puluh Kota every month UTDRS blood for transfusion are 45 to 55 bags. Survey of 30 patients who received a blood transfusion, there are 10 people have reactions such as fever of 4 people, as many as 4 people dizzy, urtikariat (itching) as much as one person and as many as three people shivering. The aim of research to find out the difference Reaction Giving Whoole Blood Transfusion Blood (WB) and Packed Red Cell (PRC) in Patients Sectio Caesare (SC). Type pre-experimental study, the design of Static Group Comparison. The population was patients post SC who receive blood transfusion, with sampling purposive sampling of 20 people. The data collection was done by direct observation, then processed and analyzed using independent t-test. Results that the average transfusion reactions in patients receiving blood transfusions WB is 1.30 and the patients who receive blood transfusion PRC is 0.40. The results of the bivariate no difference Whoole blood transfusion reaction Blood (WB) and Packed Red Cell (PRC) in Patients with Post Sectio Caesarea (SC) (p = 0.009). It was concluded that there is a difference of transfusion reactions in blood transfusions WB and blood transfusions PRC. Expected to medicine and nurse to be more selective in giving blood transfusions to patients and intensive control of blood transfusion process , so that a transfusion reaction can be immediately known. .</p><p> </p><p>Keywords: transfusion reactions, Whoole Blood (WB), Packed Red Cell (PRC)</p><p> </p><p> </p><p>Reaksi Transfusi adalah reaksi tubuh resipien terhadap darah donor, reaksi transfusi darah dapat ringan sampai berat, dan dapat berupa reaksi cepat, sedang, dan lambat. RSUD Dr. Achmad Darwis Kabupaten Lima Puluh Kota setiap bulannya UTDRS mengeluarkan darah untuk transfusi berjumlah 45 sampai 55 kantong. Survey terhadap 30 orang pasien yang mendapatkan transfusi darah, terdapat 10 orang mengalami reaksi berupa demam sebanyak 4 orang, pusing sebanyak 4 orang, menggigil sebanyak 3 orang dan urtikariat (gatal-gatal) sebanyak 1 orang. Tujuan penelitian untuk mengetahui Perbedaan Reaksi Pemberian Transfusi Darah <em>Whoole Blood </em>(WB) dan <em>Packed Red Cell </em>(PRC) pada Pasien Sectio Caesare (SC). Jenis penelitian pra eksperimen, dengan rancangan <em>Statis Group Comparison. </em>Populasi adalah pasien post SC yang mendapatkan transfusi darah, dengan pengambilan sampel secara <em>pu</em><em>rposive sampling </em>sebanyak 20 orang. Pengumpulan data dilakukan dengan cara observasi langsung, kemudian diolah dan dianalisa menggunakan <em>t-test independent</em>. Didapatkan hasil rata- rata reaksi transfusi pada pasien yang mendapatkan transfusi darah WB adalah 1,30 dan pasien yang mendapatkan transfusi darah PRC adalah 0,40. Terdapat perbedaan reaksi pemberian transfusi darah <em>Whoole Blood </em>(WB) dan <em>Packed Red Cell </em>(PRC) pada Pasien Post <em>Sectio Caesarea (SC) (p = </em>0,009). Disimpulkan bahwa ada perbedaan reaksi transfusi pada transfusi darah WB dan transfusi darah PRC. Diharapkan dokter dan perawat agar lebih selektif dalam memberikan darah transfusi pada pasien dan intensif dalam mengontrol proses transfusi darah, sehingga adanya reaksi transfusi dapat segera diketahui.</p><p> </p><p>Kata Kunci : Reaksi Transfusi, <em>Whoole Blood </em>(WB), <em>Packed Red Cell </em>(PRC)</p>

Progressive Loss of Brain Volume in Children with Sickle Cell Anemia: A Report from the Silent Cerebral Infarct Transfusion Trial Cohort

Introduction: Neurological injury is a common complication of sickle cell anemia (SCA). SCA is the most common cause of stroke in children between 1-14 years of age, while silent cerebral infarct is the most common neurologic injury in this population. Young children are particularly vulnerable to the adverse impact of strokes, and are at risk of cognitive and developmental deficits; thus, we sought to examine brain volume changes in children with SCA. The Silent Cerebral Infarct Transfusion (SIT) Trial was a multicenter trial designed to determine the efficacy of blood transfusion therapy for prevention of recurrent silent cerebral infarcts in participants with SCA. This intervention trial followed 196 children with SCA aged 5-14 years randomized to receive blood transfusion therapy or observation for 36 months (DeBaun et al. N Engl J Med. 2014;371(8):699-710). As a planned secondary analysis, we used the SIT Trial brain imaging archive to determine longitudinal brain volume change in children with SCA. We performed a multivariable analysis using demographic and clinical variables to identify predictors of brain volume change. Methods SIT participants: The current study used a subset of the registered participants (n=169) in the SIT Trial with brain MRIs at study entry and exit, demographic and clinical information. Estimation of brain volume and percent brain volume change: Baseline brain volume and longitudinal percent brain volume change (PBVC) were derived from T1-weighted structural MRIs using the automated image analysis programs SIENAX and SIENA, respectively, from the FMRIB Software Library (FSL) (www.fmrib.ox.ac.uk/fsl). For each participant, PBVC was calculated between entry and exit brain MR scans, a mean time of 41 ± 6 months. A negative PBVC indicates a decrease in brain volume and a positive PBVC indicates an increase in brain volume. All analyses were performed blinded to the participant's identity. Statistical Analysis: A multivariable linear regression analysis was used to determine predictors of PBVC. The model included the following potential covariates : demographic variables (age, gender), laboratory measures (baseline oxygen saturation, steady state hemoglobin, steady state WBC, systolic blood pressure, % Hemoglobin F, steady state reticulocytes), clinical measures (acute chest syndrome and painful crisis rates), and regular transfusions provided as part of the trial. Results: Of the 169 SIT participants, 96 were male and 73 were female, including 80 participants in the observation group and 89 in the transfusion group. Median normalized brain volume was 1,237.6 cm3 at the study entry and 1,194.7 cm3 at exit. Baseline brain volume in males was different from females (1,290.6 cm3 vs. 1,166.6 cm3; p<0.001). Comparing total brain volumes from entry to exit, the mean percent brain volume change was -2.7% (median, -2.4%; SD, 2.75). Percent brain volume change in males was not different from females (-2.6% vs. -2.8%; p=0.75). In the multivariable analysis of demographic, clinical, and pain measures, age was the only significant predictor of PBVC (p<0.001) (Figure 1). Conclusion: Using longitudinal MRI images from the SIT Trial, we demonstrate progressive brain volume loss in children, with SCA with a mean percent brain volume change of -2.7% in the SIT Trial cohort. In comparison, brain volumes of children without SCA have been reported to remain stable in this age group (Cereb Cortex. 2012; 22 (1):1-12). We conclude that loss of brain volume begins early in children with SCA. Further investigations into the etiology of brain volume loss in children with SCA, and measures to better understand and reduce or prevent brain volume loss in SCA are needed. References 1. Controlled trial of transfusions for silent cerebral infarcts in sickle cell anemia. DeBaun MR, Gordon M, McKinstry RC, et al. N Engl J Med. 2014;371(8):699-710. 2. Total and regional brain volumes in a population-based normative sample from 4 to 18 years: the NIH MRI Study of Normal Brain Development. Cereb Cortex. 2012;22(1):1-12. Figure 1. Age at randomization versus percent change in brain volume in 169 participants randomly allocated to receive blood transfusion therapy or observation for median of 36 months. Figure 1. Age at randomization versus percent change in brain volume in 169 participants randomly allocated to receive blood transfusion therapy or observation for median of 36 months. Disclosures No relevant conflicts of interest to declare.

Anaemia and Skin Pigmentation after Excessive Cupping Therapy by An Unqualified Therapist in Korea: A Case Report

A case is reported of skin pigmentation and associated anemia resulting from persistently repeated cupping therapies performed by an unqualified practitioner in South Korea. Almost 30 sessions of excessive cupping therapies with blood loss over two months yielded little benefit but led the patient to admit a hospital and receive blood transfusion for acquired iron deficiency anemia. Skin pigmentation on the cupping-attached region remained without any subjective discomfort. We suggest the importance of qualified health professionals when receiving cupping treatments.