The results of this study suggest that perioperative RBC transfusions may be significantly associated with the development of new or progressive postoperative VTE, independent of several putative confounders. These findings, if validated, should reinforce the importance of rigorous perioperative management of blood transfusion practices.

Key Points Platelet transfusions are frequently administered to hospitalized patients with platelet consumptive/destructive disorders such as TTP, HIT, and ITP. Platelet transfusions are associated with higher odds of arterial thrombosis and mortality among TTP and HIT patients.

Childhood-onset Takayasu arteritis (c-TA) is a distinct subset affecting a wide age group, ranging from young infants to adolescents and it differs from adult TA in many aspects. There is scarcity of data on c-TA worldwide. The disease is classified using the European League Against Rheumatism/Pediatric Rheumatology International Trials Organization/Pediatric Rheumatology European Society criteria. The non-specific nature of presenting complaints and lack of appropriate biomarkers delay the early diagnosis of this illness and many children present with complications, which become irreversible once they set in. One of the largest cohorts of 40 children with c-TA from our center reports hypertension as the commonest presenting feature. Systemic symptoms like headache, fever and weight loss are also described. Assessment of disease in c-TA is done by correlating clinical features with raised inflammatory markers. Advanced imaging plays an important role in diagnosis. In c-TA, the role of magnetic resonance angiography is advocated, taking into consideration the enormous amount of radiation exposure with other modalities. Complications of c-TA include cardiovascular, pulmonary, neurological and those arising secondary to long-term steroid and immunosuppression therapy.

RBCs transfused in the last 7 days of their 42-day storage limit may be associated with adverse clinical outcomes in high-risk patients.

Despite aggressive immunosuppression, damage progressed in one-third of patients with c-TA in association with persistent inflammation, warranting surveillance with clinical instruments and followup imaging.

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Blood transfusions are one of the most common hospital procedures. Randomized trials have demonstrated the safety of restrictive transfusion strategies. 1 Hospitals have subsequently implemented patient blood management programs to facilitate restrictive transfusion practices aimed to improve patient outcomes, reduce costs, and conserve blood. We are unaware of nationally representative studies evaluating temporal trends in red blood cell (RBC), plasma, and platelet transfusions while accounting for the influence of patient-level or hospitallevel characteristics.

Background Despite proven efficacy and increased availability of therapeutic plasma exchange (TPE), mortality for patients with thrombotic thrombocytopenic purpura (TTP) remains high with a limited understanding of those at highest risk of death. Study Design and Methods This study utilized the Nationwide Inpatient Sample (2007–2012) to derive a prognostic score for mortality in hospitalized TTP patients. Odds ratios of death with various putative risk factors adjusted for age, gender and race were calculated (adjOR). Weighted average of adjOR estimates were incorporated in a risk stratified score. Results Among 8203 hospitalizations with TTP as primary admission diagnosis who underwent TPE, 613 deaths were identified (all-cause mortality 7.5%, median time-to-death 9 days with interquartile range 4–14 days). In multivariable logistic regression, arterial thrombosis (adjOR 6.7, 95%CI=1.1–40.9), intra-cranial hemorrhage (adjOR 6.1, 95%CI=1.6–23.2), age >=60 years (adjOR 3.5, 95%CI=2.1–5.6), renal failure (adjOR 2.6, 95%CI=1.5–4.5), ischemic stroke (adjOR 2.4, 95%CI=1.2–5.0), platelet transfusions (adjOR 2.2, 95%CI=1.2–4.1) and myocardial infarction (adjOR 2.3, 95%CI=1.2–4.6) were significant independent predictors of mortality in TTP patients who underwent TPE. A prognostic weighted mortality prediction scoring system incorporating arterial thrombosis, intracranial hemorrhage, age, renal failure, ischemic stroke, platelet transfusion and myocardial infarction showed very good discrimination and was predictive of 78.6% deaths. Conclusions Early and targeted therapy for high risk individuals should be used to guide management of TTP patients for improved survival outcomes.