14 July 2021 (Wednesday) - Transfusion Evidence Alert Update

The nice people at the Transfusion Evidence Alert sent their update today. One of my better sources of CPD, but again too much for my poor brain to cope with in one sittng:

Top 10 new articles: June 2021 Each month, the NHS Blood and Transplant Systematic Review Initiative provides an overview of the most important new publications in transfusion medicine. All content is sourced from the Transfusion Evidence Library. COVID-19 publications are included in this alert. +++++

ARTICLE OF THE MONTH Therapeutic versus prophylactic anticoagulation for patients admitted to hospital with COVID-19 and elevated D-dimer concentration (ACTION): an open-label, multicentre, randomised, controlled trial. Lopes, R.D., et al. (2021). Lancet. PICO Summary available +++++

TOP ARTICLES Heart Failure Hospitalization in Adults Receiving Hemodialysis and the Effect of Intravenous Iron Therapy. Jhund, P.S., et al. (2021).JACC. Heart failure. Plasma trial: Pilot randomized clinical trial to determine safety and efficacy of plasma transfusions. Carson, J.L., et al. (2021). Transfusion. [Record in progress] Use of electronic self-administered bleeding assessment tool in diagnosis of paediatric bleeding disorders. Kaur, D., et al. (2021). Haemophilia [Record in progress] Early Prehospital Tranexamic Acid Following Injury is Associated with a 30-day Survival Benefit: A Secondary Analysis of a Randomized Clinical Trial. Li, S.R., et al. (2021). Annals of Surgery. [Record in progress] Hemoglobin levels as a transfusion criterion in moderate to severe traumatic brain injury: a systematic review and meta-analysis. Florez-Perdomo, W.A., et al. (2021). British Journal of Neurosurgery. [Record in progress] Tranexamic acid given into wound reduces postoperative drainage, blood loss, and hospital stay in spinal surgeries: a meta-analysis. Hui, S., et al. (2021). Journal of Orthopaedic Surgery and Research. Contemporary Management and Prevention of Vaso-Occlusive Crises (VOCs) in Adults With Sickle Cell Disease. Weaver, S.B., et al. (2021). Journal of Pharmacy Practice. [Record in progress] Roxadustat for the treatment of anemia in patients with chronic kidney diseases: a meta-analysis. Zhang, L., et al. (2021). Aging. +++++

TOP COVID-19 ARTICLES

Gastrointestinal bleeding in covid-19 patients: A systematic review and meta-analysis.
Marasco, G., et al. (2021). Endoscopy.

12 July 2021 (Monday) - Getting The Red Light

I seem to do a BTLP-TACT exercise every morning before a night shift, so here we go…
I was presented with two patients:

57372 – an eighty year old chap from the vascular clinic requiring group and save
He typed as A Rh(D) Positive with a negative antibody screen

30703 – a nineteen year old chap from the haematology clinic requiring eight units of blood as soon as possible. His blood group was indeterminate but Rh(D) Negative. There was something odd in the A cells - is he A2B with anti A1?
And to complicate matters he had a positive antibody screen with cells 2 and three reacting. I requested antibody panels and the IAT panel was positive in cells 1, 3, 4, 6 and 7… And that was when the power went off as the nice man from EDF was changing the electricity meter.
Two hours later the power went back on and I saw from what I had copied and saved elsewhere that this corresponded with anti-Jk(a). The enzyme panel was the same.
So… bearing in mind the blood group I wanted eight units of O Neg Jk(a) Negative blood.

I found two…

I got the red light…  because I didn’t supply enough blood. There were only two Jk(a) Negative units available. What was I supposed to do?

9 July 2021 (Friday) -ASH Update

The nice people from the American Society of Hematology sent their update today. Perhaps a tad more clinical than I would prefer, but it was all useful reading:

Post-Transplant MRD Monitoring With Non-DTA Mutations Predicts Outcomes in AML In next-generation sequencing-based MRD monitoring, the use of non-DNMT3A, TET2, or ASXL1 mutations may predict relapse and survival following allogeneic hematopoietic cell transplantation for patients with AML.

Are Physician Perceptions of Transfusions a Barrier to Hospice Enrollment for Patients With AML? The tendency of patients with AML and their caregivers to defer end-of-life transfusion decisions to clinicians without participating in shared decision-making may delay hospice admission in patients who would benefit from this care the most.

Survival Outcomes After HLA-Haploidentical Relative Versus Matched Unrelated Donor Transplant in Acute Leukemias and MDS In patients with acute leukemias, those who underwent haploidentical relative hematopoietic cell transplantation had higher rates of grade 3-4 graft-versus-host disease and mortality compared with those who underwent transplant with a matched unrelated donor.