The number of Jehovah's Witnesses worldwide is estimated at approximately 8.6 million. As Jehovah's Witnesses refuse administration of blood and blood-derived products on religious grounds, transfusion of red blood cells is not an option. It is especially problematic when anaemia develops acutely, as in non-elective surgery, as there is no time to optimise volume of red blood cells preoperatively. We present a case of an 86-year-old woman who underwent non-elective laparoscopic cholecystectomy due to gangrenous cholecystitis. Post-operatively the patient was hospitalised in an intensive care unit where the haemoglobin concentration reached nadir of 44 g L-1. Despite developing severe anaemia, the patient survived and did not suffer from long-term sequelae. To our knowledge, the patient presented here was the oldest patient who survived anaemia of such severity to date. When deciding on red blood cells transfusion clinicians should consider patient's physiologic response to anaemia, as tolerance of anaemia is variable among patients. Even elderly patients may tolerate severe anaemia, as it has been shown in our care report.
Introduction: Anaemia is associated with a wide range of negative outcomes. Diagnostic blood loss (DBL) may contribute to its occurrence. We aimed to evaluate DBL and its impact on haemoglobin (HGB) concentration and developing anaemia in the intensive care unit (ICU) patients. Methods: A study group comprised of 36 adult ICU patients. DBL during 7 consecutive, post-admission days was calculated. Anaemia occurrence was assessed using the WHO thresholds. Data on HGB and haematocrit (HCT) was subjected to analysis. Results: Upon admission, 24 (67%) patients were diagnosed with anaemia, on the eighth day 29 (80%) subjects (with 6 new cases). The median volume of blood collected was 143.15 mL (IQR 121.4–161.65) per week. No differences in DBL were found between the subjects with newly developed anaemia and their counterparts (p=0.4). The median drop of HGB (HbΔ) was 18 gL–1 (IQR 5–28) and the median drop of haematocrit (HtΔ) was 4.55% (IQR 1.1–7.95). There was no correlation between neither HbΔ and DBL (p=0.8) nor HtΔ and DBL (p=0.7). There were also no differences in HbΔ/HtΔ when age, gender or the primary critical illness were taken into account for the analysis (p>0.05 for all). The 7-day fluid balance was associated with haemoglobin drop (R=0.45; p=0.006). Conclusions: Anaemia is frequent in ICU patients. Diagnostic blood loss in our institution is acceptable and seems to protect patients against significant iatrogenic blood loss and subsequent anaemia. Dilutional anaemia may interfere with the results so before-after interventional research is needed to explore this interesting topic.
Introduction. Reliable results of an arterial blood gas (ABG) analysis are crucial for the implementation of appropriate diagnostics and therapy. We aimed to investigate the differences (Δ) between ABG parameters obtained from point-of-care testing (POCT) and central laboratory (CL) measurements, taking into account the turnaround time (TAT). Materials and methods. A number of 208 paired samples were collected from 54 intensive care unit (ICU) patients. Analyses were performed using Siemens RAPIDPoint 500 Blood Gas System on the samples just after blood retrieval at the ICU and after delivery to the CL. Results. The median TAT was 56 minutes (IQR 39-74). Differences were found for all ABG parameters. Median Δs for acid-base balance ere: ΔpH=0.006 (IQR –0.0070–0.0195), ΔBEef=–0.9 (IQR –2.0–0.4) and HCO3–act=–1.05 (IQR –2.25–0.35). For ventilatory parameters they were: ΔpO2=–8.3 mmHg (IQR –20.9–0.8) and ΔpCO2=–2.2 mmHg (IQR –4.2––0.4). For electrolytes balance the differences were: ΔNa+=1.55 mM/L (IQR 0.10–2.85), ΔK+=–0.120 mM/L (IQR –0.295–0.135) and ΔCl–=1.0 mM/L (IQR –1.0–3.0). Although the Δs might have caused misdiagnosis in 51 samples, Bland-Altman analysis revealed that only for pO2 the difference was of clinical significance (mean: –10.1 mmHg, ±1.96SD –58.5; +38.3). There was an important correlation between TAT and ΔpH (R=0.45, p<0.01) with the safest time delay for proper assessment being less than 39 minutes. Conclusions. Differences between POCT and CL results in ABG analysis may be clinically important and cause misdiagnosis, especially for pO2. POCT should be advised for ABG analysis due to the impact of TAT, which seems to be the most important for the analysis of pH.
Introduction. It is speculated that preeclampsia and hypertension during pregnancy are associated with an imbalance of the placental antioxidant defence, which results in the overproduction of reactive oxygen species and fetal growth restriction. Many research implied that oxidant stress in utero may be an important determinant of mortality and morbidity in neonates. Moreover, the authors demonstrated the reduced number of nephrons and a higher prevalence of renal injury in neonates with growth restriction, including small for gestational age (SGA) neonates. Alas, it remains unclear whether basal antioxidant status is altered in the kidneys of SGA newborns. Materials and Methods. In this study, we assessed neutrophil gelatinase-associated lipocalin (NGAL) and malondialdehyde (MDA) levels in samples collected from umbilical blood and 12 hours after delivery in neonates born by mothers suffering from preeclampsia or hypertension during pregnancy and those from physiological pregnancies. Additionally, the authors evaluated levels of the aforementioned biomarkers regarding the occurrence of growth restriction in newborns. For this study, we enrolled 27 newborns, which fulfilled inclusion criteria for SGA diagnosis (SGA group), while 21 were appropriate for gestational age neonates, as the AGA group. Results. In the presented study, we have found significant differences in umbilical cord MDA and NGAL concentration between the SGA and AGA groups. Such dependencies were not found in blood samples from neonates collected in the first 12 hours of life for MDA and NGAL concentrations. Additionally, we have observed differences in umbilical MDA and NGAL levels between newborns of preeclamptic or hypertensive mothers compared to healthy ones. A significant correlation between the occurrence of hypertension during pregnancy and umbilical MDA and NGAL concentrations was also found. Conclusions. Small for gestational age newborns or those born by preeclamptic and hypertensive mothers had significantly higher MDA and NGAL levels as compared to healthy ones. Further investigation is needed to understand the pathophysiologic influence of hypertension in pregnancy and oxidative stress injury in newborns with growth restriction.
Perinatal hypoxia is one of the more common complications of the early adaptation period. This condition is defined as a disorder of tissue oxygenation during labour and is responsible for approximately 23% of neonatal mortality. Perinatal hypoxia can cause injury and failure of many organs, including the brain, heart and kidneys, mainly in the mechanism of the ischaemic-reperfusion injury. Currently, biochemical markers are more frequently incorporated in neonatal diagnostics. Routinely used in adult patients, these organ-specific chemicals enable diagnosis with high sensitivity and specificity. The manuscript presents a review of research on the use of cardiac markers (N-terminal fragment of pro-B-type natriuretic peptide, cardiac troponins I and T, and cardiac creatine kinase isoenzyme) in selected neonatal diseases. Still, no cutoff values have been established for any of the markers described in this paper. Therefore, for routine use of cardiac markers in the neonatal population, further studies are needed to determine the range of cutoff values and factors that may cause their fluctuation.
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