Effect of storage on biochemical parameters of packed red blood cells of goats in............ 257-261 citrate phosphate dextrose adenine/ saline adenine glucose mannitol

A study was conducted to assess the suitability of citrate phosphate dextrose adenine / saline adenine glucose mannitol as a storage media for packed RBCs of goats. Samples collected from ten apparently healthy goats were utilized for the study. Biochemical studies were carried out on day 0, 14, 28 and 42 days of storage using the parameters, viz. pH, glucose, potassium, malondialdehyde and reduced glutathione. The pH was stable throughout the study, whereas glucose showed significant reduction. Rest of the parameters increased significantly from 0th day to 42nd day. Based on the results, the storage media can be considered to be suitable for storing caprine packed RBCs.

Transfusion Strategies in Patients with Mitral Valve Replacement

The aim. To carry out research of liberal, restrictive and blood-saving transfusion strategies in patients with mitral valve replacement (MVR) in the conditions of artificial blood circulation during operation, in intensive care unit, and in the postoperative period. Material and methods. Retrograde examinations were performed in 70 patients who underwent surgery for ac-quired mitral valve disease. Our research consisted of three stages: stage 1 involved the study of the volume of transfu-sions of donor blood components during MVR, stage 2 involved the study of the volume of transfusion of donor blood components in the emergency room, stage 3 involved the study of the volume of transfusions of donor blood components in the intensive care unit. All the patients were divided into 3 groups. Group A included 14 patients in whom (arbitrary) liberal transfusion strategy (LTS) with transfusion of donor blood components was applied during the operation. Group B included 19 patients in whom (economical) restrictive transfusion strategy (RTS) during surgery with transfusion of donor blood components was applied. Group C included 37 patients in whom the patient’s autologous blood-saving tech-nology (BST) was applied during the operation. Results and discussion. At stage 1 of the study, the volume of packed RBCs per 1 transfusion in group A exceeded the volume of packed RBCs per 1 transfusion in group B by 68.0%. The volume of transfusions of native fresh-frozen plasma (FFP) in group A exceeded that in group B by 73.5%. The volume of platelet transfusions (PT) in group A at stage 1 was 75.0%. At stage 2 of the study, the total volume of PT in patients of group A was still 3.0 times higher and FFP was 2.7 times higher than that in group B. At this stage of the study, there was also a 2.6-fold decrease in the volume of PT per 1 transfusion in group B compared with group A. In total, during 3 stages of the study, the volume of PT use in group A was 5.7 times higher, and in group B it was 3.9 times higher than that in group C. The volume of FFP use in group A was 4.4 times higher, and in group B it was 3.8 times higher than that in group C. Conclusions. The use of LTS in group A and RTS in group B resulted in 5.2-fold and 3.8-fold increase in the total volume of transfused donor blood components, repsectively, compared to group C.

THE EFFECTIVENESS OF STRUCTURED TEACHING MODULE ON PREVENTION OF ANAEMIA AMONG ADOLESCENT GIRLS

Anemia is a clinical condition that results from an insufficient supply of healthy red blood cells to oxygenate the body’s tissue adequately; results in hypoxia1 . It is a deficiency in the number of erythrocytes, the quantity of hemoglobin and or the volume of packed RBCs. Iron deficiency anemia is a condition due to decreased hemoglobin synthesis. It typically results when the intake of dietary iron is inadequate for hemoglobin synthesis. The findings of this study support the need for Community Health Nurse to conduct health education programme, to increase the knowledge of the adolescent girls regarding prevention of anaemia. Key words: Anemia, Adolescent Girl, Prevention, Knowledge

Activated Factor Seven (aFVII) versus Aminocaproic Acid for Treatment of Traumatic Retro-Peritoneal Hematoma

Introduction: Off-labelled use of activated Factor VII (aFVII) in severe traumatic bleeding has been used as an alternative to aminocaproic. Aim of Work: The aim of this study is to compare the efficacy of aFVII with aminocaproic acid in the medical treatment of retroperitoneal bleeding, treatment of hypovolemic shock and preventing complications of massive blood transfusion. Materials and Methods: 80 patients with traumatic retro-peritoneal hematoma were allocated into two groups of 40 patients each. Patients in Group A received aminocaproic acid, while patients of group B received aFVII. The number of packed RBCs given to achieve the target Hb level and time to get to this target Hb level (>10 gm%) were recorded as indicators of control bleeding. Blood pressure, pulse, arterial blood gasses and urine output were recorded as indicators of successful treatment of hypovolemic shock. Hypoxic index, chest X-ray and coagulation profile were used as indicators for complications. Results: There was a significantly smaller number of packed RBCs given to patients of group B to achieve the target Hb level and this target Hb level was achieved in a shorter time. There was a significantly higher number of patients in group B compared to group A who had normal blood pressure, pulse and urine output, pH and bicarbonate concentration. There was a significantly smaller number of patients who developed DIC and TRALI in group B compared to group A. Conclusion: aFVII was more effective than aminocaproic acid and needed a shorter time to stop retroperitoneal bleeding, treat hypovolemic shock, restore adequate tissue perfusion and protect patients from complications of massive blood transfusion.

Time to Catheter Angiography for Gastrointestinal Bleeding after Prior Positive Investigation Does Not Affect Bleed Identification

Objective: To determine, time to angiography for patients with positive gastrointestinal bleeding (GIB) on prior investigation (endoscopy [ES], nuclear medicine [NM] Tc99m red blood cells (RBC) scan, or computed tomography angiography), affects angiographic bleed identification. Materials and Methods: Visceral Angiograms performed from January 2012 to August 2017 were evaluated. Initial angiograms performed for GIB were included in the study. Exclusion criteria included recent abdominal surgery or procedure (30 days), empiric embolization (embolization without visualized active bleeding), and use of vasodilators, or subsequent angiogram. Timing and results of ES, NM Tc99m RBC scan, or computed tomography angiogram and catheter angiogram were recorded. In addition, age, gender, angiogram time, anti- platelet therapy, anti-coagulation therapy, bleed location, international normalized ratio, and units of packed RBCs received in the 24 h before catheter angiography were included in the study. Results: One hundred and seventy angiograms were included in the final analysis. Forty-three angiograms resulted in the identification of an active bleed (68.9 years, and 67.4% male). All of these patients were embolized successfully. One hundred and twenty-seven angiograms failed to identify an active bleed (70.4 years, and 49.6% male). No significance was found across the two groups with respect to time from prior positive investigation. Receiver operating characteristic analysis demonstrated that units of packed RBCs received in the preceding 24 h were correlated with positive bleed identification on catheter angiography. Conclusion: Time to angiography from prior positive investigation, including ES, NM Tc99m RBC scan, or computed tomography angiogram does not correlate with positive angiographic outcomes. Increasing units of packed RBCs administered in the 24 h before angiogram do correlate with positive angiographic findings.

In Contrast to Platelet Microparticles, Red Cell Microparticles Are Anti-Inflammatory, Judging By Effect on CD11b Expression on Neutrophils

BACKGROUND: It has been shown that platelet microparticles (PMP) exert pro-inflammatory activity. It has also been suggested that red cell MP (RMP) are similarly pro-inflammatory, but the evidence is less clear. This issue has clinical significance for several reasons. For example, there is evidence that both PMP and RMP have hemostatic activity [Horstman et al, Semin Thromb Hemost, 2019] and that infusion of RMP is a viable strategy for control of excessive bleeding [Jy et al,Thromb Haemost, 2013]. For these reasons we undertook assay of inflammatory potential of PMP and RMP by the method of CD11b expression on neutrophils, using N-Formylmethionyl-leucyl-phenylalanine (fMLP) as a positive control. METHODS: RMP were isolated from leukoreduced, type O+ packed RBCs obtained from three different donors at storage time points of 3 and 6 weeks (RMPStor). In addition, RMP were prepared by high-pressure extrusion from type O+ packed RBCs stored for less than one week (RMPxt). Platelets were isolated from healthy volunteers and sonicated to produce PMP. MP concentrations were determined using flow cytometry. RMP were identified by PE-labeled anti-glycophorin and PMP were identified by FITC-labeled anti-CD41. Each MP species was added to separate 500 µL aliquots of fresh whole blood collected from healthy volunteers for equal final concentrations of 20,000/µL, 40,000/µL, 80,000/µL, and 200,000/µL. To one of each pair, fMLP was added for a final concentration of 1 µM. Fresh, whole blood treated with sterile saline was used as a negative control. A positive control was obtained by adding fMLP to whole blood without MP treatment. The blood samples were then incubated for one hour under gentle shaking. Two-color flow cytometry with PE-Cy5-anti-CD11b and FITC-anti-CD45 MAbs were employed to measure the ratio of CD11b to CD45 expression on neutrophils (identified through FS, SS, and CD45+ FL gating). The differences in CD11b expression were compared using the paired t test. The mean values presented below were determined using the results from at least 5 replicate experiments in which the two groups were directly assayed against one another using neutrophils from a single donor, resulting in slightly different mean values for each group depending on the comparison being analyzed. RESULTS: For all RMP species, there was no significant difference between concentration and their effect on neutrophil CD11b expression. In contrast, the concentration of PMP positively correlated with an increase in CD11b expression (R2=0.78). At a MP concentration of 200,000/µL, there was no statistical difference when comparing neutrophil CD11b expression in the negative control vs. incubation with RMPxt (27.5 vs. 27, p=0.7), or the negative control vs. incubation with RMPStor Wk 6 (29.0 vs. 28.4, p=0.6). However, neutrophil CD11b expression was lower when incubated with RMPStor Wk 3 compared to the negative control (25.1 vs. 28.8, p<0.03). In comparison, incubation with PMP increased CD11b expression to nearly 200% of the negative control (44.2 vs. 22.1, p<0.0001). All phenotypes of RMP inhibited fMLP-induced CD11b expression. Compared to the positive control, RMPxt decreased CD11b expression by 12% (73.4 vs 64.6, p=0.0003), RMPStor Wk 3 decreased CD11b expression by 19% (77.5 vs. 62.8, p<0.0001), and RMPStor Wk 6 decreased CD11b expression by 12% (77.3 vs. 68.4, p=0.0002). Conversely, PMP potentiated fMLP-induced CD11b expression by 20% when compared to the positive control (90.7 vs. 72.7, p<0.007). CONCLUSION: In sum, PMP exhibited robust pro-inflammatory activity, but RMP did not. On the contrary, RMP exhibit modest but significant anti-inflammatory activity in this assay method. It remains necessary to elucidate the mechanism and to assess if these findings apply in vivo. Disclosures Jy: RxMP Therapeutics: Consultancy, Equity Ownership, Patents & Royalties: US patents No. 8,150,632 and 9,155,764, Research Funding. Horstman:RxMP Therapeutics: Patents & Royalties: US patents No. 8,150,632 and 9,155,764. Ahn:RxMP Therapeutics: Consultancy, Equity Ownership, Patents & Royalties: US patents No. 8,150,632 and 9,155,764, Research Funding.

Cryopreservation of feline red blood cells in liquid nitrogen using glycerol and hydroxyethyl starch

ObjectivesThe objective of this study was to evaluate the techniques and short-term effects of cryopreservation of feline red blood cells (RBCs) in liquid nitrogen using glycerol or hydroxyethyl starch (HES) as a cryoprotectant.MethodsFeline RBCs were manually mixed with either 20% glycerol or 12.5% HES and frozen for 24 h in liquid nitrogen. The samples were thawed and glycerolized samples were manually washed. Success of the freeze/thaw process was determined by recovery rate of RBCs and evaluation of morphological changes using scanning electron microscopy (SEM). A unit of canine packed RBCs was also subjected to the same methodology to evaluate the cryopreservation handling technique.ResultsFeline RBCs preserved with 20% glycerol had a high recovery rate (94.23 ± 1.25%) immediately after thawing. However, the majority of the cells were lost during the washing process, with a final packed cell volume of <1%. A recovery rate was unable to be assessed for samples preserved with HES owing to the high viscosity of the mixture. SEM revealed significant morphological changes after glycerol was added to the feline RBCs. Although these morphological changes were partially reversed after thawing, the majority of the RBCs were lost during the washing process. Minimal morphological changes were noted in the HES sample. Similar results were noted with the canine RBCs.Conclusions and relevanceThe described manual technique for cryopreservation using glycerol was not able to successfully preserve feline or canine RBCs. In the present study, it was difficult to make conclusions about the efficacy of HES. Further studies evaluating HES as a cryoprotectant are warranted.

Possible Trimethoprim–Sulfamethoxazole-Induced Hemolytic Anemia: A Case Report

Objective: To report a case of hemolytic anemia in a patient who received trimethoprim/sulfamethoxazole (TMP-SMX) for a urinary tract infection (UTI). Summary: A 47-year-old woman recently diagnosed with uncomplicated UTI received 3 doses of TMP-SMX. She developed yellowing of the skin and eyes, lethargy, mild abdominal pain, and dry mucous membranes. Laboratory testing demonstrated significant anemia with red blood cells (RBCs) of 1.99, hemoglobin (Hgb) of 6.3 g/dL, and hematocrit (Hct) of 18.1%. TMP-SMX was immediately discontinued. The patient was given methylprednisolone 60 mg intravenously (IV) followed by oral steroids and infused with 3 units of packed RBCs over the course of a 10-day inpatient admission. On discharge, the patient continued oral steroids. Outpatient follow-up indicated Hgb of 11.0 g/dL and Hct of 32.7%, 41 days after hospital discharge. Utilizing the Naranjo adverse drug reaction probability scale, there is a probable association between the patient’s hemolytic anemia and TMP-SMX. Conclusion: We report a case of hemolytic anemia resulting from the use of TMP-SMX. Although this is a rare adverse effect, clinicians should be aware of the signs and symptoms of hemolytic anemia, and so appropriate treatment can be administered should it occur.

Chemotherapy Used to Halt Lower GI Bleeding in a Rare Case of Metastatic Choriocarcinoma to the GI Tract

Choriocarcinoma, a nonseminomatous germ cell tumor, is a rare type of testicular malignancy that tends to occur in young males. It is, however, exceedingly rare for choriocarcinoma to involve the GI tract. In this article, we present a rare case of a 31-year-old male, diagnosed with choriocarcinoma of the left testes, along with several metastases to distant sites. The patient presented with headaches and severe lower GI bleeding due to metastases to the GI tract, which was eventually controlled with systemic chemotherapy, while requiring several units of packed RBCs during his admission to the hospital. An extensive literature review found very few cases of the occurrence of GI bleeding as a consequence of choriocarcinoma due to metastases to the GI tract.