Evaluating patient blood management practices using PBM metrics in a tertiary care center

BACKGROUND

PBM metrics play a crucial role in assessing and monitoring the effectiveness of PBM programs in healthcare settings. The present study aimed to assess the indicators to achieve effective enforcement of PBM at a tertiary care referral hospital.

SUBJECTS AND METHOD

A prospective observational study was conducted on patients admitted for elective surgery at a tertiary care referral centre. PBM metrics were developed and assessed for various parameters, including documentation, patient evaluation, blood ordering schedule, and appropriateness. Experts in transfusion medicine and haematology checked content validity. Eleven different parameters were analysed, and a score was assigned based on the performance. The outcome was categorized as poor, satisfactory, or good.

RESULTS

The study included 612 patients meeting the inclusion criteria and recruited from Orthopaedics, General Surgery, OBG, Urology, and ENT departments. All departments completed pre-operative anaemia tests, with General Surgery and Orthopaedics conducting the most red cell transfusions. During the study, all of the blood units were used, and there was no waste. The C/T ratio was greater in the Departments of General Surgery, Urology, and Otorhinolaryngology. Pre-operative anaemia was found in 44.12% of patients, 44 patients had red cell transfusions, with 65% getting single-unit PRBC transfusions. All departments received a PBM score between 17-19, showing adequate PBM but with room for improvement.

CONCLUSION

The current study utilized Patient Blood Management (PBM) metrics to critically assess the existing practices and identify the key gaps and areas for improvement in a tertiary care centre.

Are analytical performance specifications derived from reference intervals of any use in the veterinary clinical laboratory? A preliminary study on the empirical biological variation model

BACKGROUND

Analytical performance specifications (APS) are vital for method evaluation and quality control validation. However, the limited availability of biological variation (BV) data, regulatory guidelines, and expert opinion (EO) may present challenges in veterinary medicine. The empirical biological variation (EBV) approach, based on population reference intervals (pRI), has emerged as an alternative method to derive APS in human medicine.

OBJECTIVES

This study aimed to assess the practicality and usefulness of the EBV approach in deriving performance limits for various measurands in dogs and cats.

METHODS

Eight hematology and 13 biochemistry measurands were analyzed in dogs and cats. Estimates of combined biologic variation based on traditional biological (CVB ) and EBV-derived (CVE *) formulas were calculated and assessed for evidence of correlation. Performance limits for expanded uncertainty/total error and imprecision were compared among EO, BV, and EBV.

RESULTS

Strong and significant correlations were found between CVB and CVE * for both dogs (r = .86, p < .00001) and cats (r = 0.95, p < .00001). The EBV-derived APS were generally comparable to EO and BV, with a subjective criterion of 1.5% difference for imprecision and 3% for total error/expanded uncertainty.

CONCLUSION

The EBV approach, using pRI, shows promise as a surrogate marker for biological variation and as a practical tool for determining performance limits in dogs and cats. Assuming accurate pRI generated on analyzers with stable analytical performance, this approach could offer benefits when expert recommendations or robust BV studies are lacking or yield conflicting results. Further research is needed to explore the applicability and advantages of the EBV in veterinary medicine.

Laboratory practice is central to earlier myeloma diagnosis: Utilizing a primary care diagnostic tool and laboratory guidelines integrated into haematology services

Treatment advances have greatly improved survival, but myeloma is among the worst of all cancers for delayed diagnosis, causing serious morbidities and early deaths. This delay is largely because the symptom profile of myeloma has very low specificity, and in primary care, myeloma is rare. However, initiating the journey to diagnosis simply requires considering myeloma and sending blood to test for monoclonal immunoglobulin. Laboratory tests reliably detect monoclonal immunoglobulin, which is present in 99% of myeloma cases, so why do health care systems have such a problem with delayed diagnosis? The Myeloma UK early diagnosis programme has brought together diverse expertise to investigate this problem, and this article was prepared by the programme's working group for laboratory best practice. It reviews evidence for test requesting, analysis and reporting, for which there is large variation in practice across the United Kingdom. It presents a 'GP Myeloma diagnostic tool' and how it can be integrated into laboratory practice alongside a laboratory best practice tool. It proposes improved requesting and integration with haematology services for reporting and interpretation. Here the laboratory has a central role in creating efficient and cost-effective pathways for appropriate and timely bone marrow examination for myeloma diagnosis.

Child Health and the Pediatric Hematology-Oncology Workforce: 2020-2040

Pediatric hematology-oncology (PHO) is 1 of the oldest recognized pediatric subspecialities. PHO physicians care for infants, children, adolescents, and young adults with all types of cancer and nonmalignant blood conditions, in many cases temporarily assuming the role of a primary care physician because of the complexity and intensity of treatment. However, the number of clinically active PHO subspecialists needed to care for children in the United States remains unknown. Recent papers suggest a potential oversaturation of PHO physicians in some geographic areas. This article is part of a Pediatrics supplement focused on projecting the future supply of the pediatric subspecialty workforce. It draws on information available in the literature, data from the American Board of Pediatrics, and findings from a new microsimulation model estimating the future supply of pediatric subspecialists through 2040. The model predicts a workforce growth in PHO subspecialists of 66% by 2040. Alternative scenarios, including changes in clinical time and fellowship size, resulted in a difference in growth of ±18% from baseline. The model also forecasts significant geographic maldistribution. For example, the current workforce is concentrated in the Northeast Census region and the model predicts the New England Census division will have a 2.9-fold higher clinical workforce equivalent per 100 000 children aged 0 to 18 years than the Mountain Census division by 2040. These findings suggest potential opportunities to improve the PHO subspecialty workforce and the outcomes and experiences of its patient population through educational changes, practice initiatives, policy interventions, and dedicated research.

Assessment of the hematological profile of children with chronic kidney disease on follow-up at St. Paul's Hospital Millennium Medical College and Tikur Anbessa Specialized Hospital in Addis Ababa, Ethiopia

BACKGROUND

Chronic kidney disease (CKD) is a major public health issue with an increasing incidence and prevalence worldwide. In CKD, hematological parameters are influenced, and the effect increases with CKD stage. Thus, the aim of this study was to assess hematological profile of children with CKD on follow up at Tikur Anbessa Specialized Hospital and St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia.

METHODS

A cross-sectional study was carried out from March 1 to June 30, 2021 among 238 children with CKD. EDTA tubes were used to collect 4 ml blood samples, which were then examined by Beckman Coulter automated hematology analyzer. SPSS Version 20 was used for statistical analysis, and a bivariate and multivariate regression model were applied to assess correlations. Mean and standard deviation was used to determine hematological profiles.

RESULTS

The total number of patients in the study were 238, with 42 (59.7%) of them being men. The majority of the patients (81%) had CKD stage 1. Mean ± standard deviation determined for white blood cell (WBC) parameters in (thousand/µL); WBC, Neutrophil, Lymphocytes, Eosinophil, Monocytes and Basophil were 8.93 ± 3.32, 4.6 ± 8.31, 2.79 ± 1.62, 0.31 ± 0.51, 0.50 ± 3.03 and 0.03 ± 0.24, respectively. For some of red blood cell (RBC) parameters; RBC (million/ µL), Hemoglobin (Hgb) (g/dL), Hematocrit (Hct) (%) and Mean cell volume (fl.) were 4.73 ± 0.87, 12.82 ± 2.76, 38.28 ± 7.53 and 80.32 ± 7.89, respectively. For the platelet count (PLT) (thousand/µL) and Mean Platelet volume (MPV) (fL) 349.34 ± 130.18 and 9.03 ± 4.31 were determined, respectively. This study also found hematologic parameters such as RBC, HGB, HCT and MPV were found to be positively correlated with eGFR with a P-value < 0.05 for all parameters.

CONCLUSION

The study found that the majority of study participants were in stages 1 to 3 based on their estimated glomerular filtration rate (eGFR). Some of hematological parameters found to have positive correlation with eGFR. There is a need to improve multiple aspects of CKD management, including routine hematological tests for children with chronic kidney disease.

[Analysis of the clinical characteristics of acute myeloid leukemia related to the treatment of hematological and solid tumors]

Objective: To compare and analyze the clinical characteristics of acute myeloid leukemia (AML) related to the treatment of hematological tumors and solid tumors. Methods: The laboratory and clinical data of 41 patients with treatment-related AML (t-AML) in the Department of Hematology, Henan Cancer Hospital from January 2014 to December 2021 were retrospectively analyzed, and they were divided into hematological tumor group and solid tumor group. Survival analysis was performed using the Kaplan-Meier method and Log rank test. Results: The median interval from the first tumor diagnosis to t-AML in 41 patients was 21.0 (16.5-46.0) months; 24 (58.5%) had abnormal expression of lymphoid antigen, 28 (68.3%) had abnormal karyotype, 18 cases (43.9%) were positive for fusion gene, and 28 cases (68.3%) were positive for gene mutation; the median recurrence-free survival (RFS) was 11.0 months, and the median overall survival (OS) was 11.5 months. The proportion of acute promyelocytic leukemia ([APL], 0.0, 0/13), complete response ([CR],18.2%, 2/11), median OS (4.5 months) and median RFS (2.5 months) of t-AML patients in the hematological tumor group were significantly lower than those in the solid tumor group (35.7%, 10/28; 68.0%, 17/25; not reach; not reach), but the proportion of M4 /M5 (93.2%,12/13) was significantly higher than that in the solid tumor group (53.6%,15/18; all P values<0.05). Through subgroup analysis, the proportion of patients with positive PML-RARa and good prognosis karyotypes in the solid tumor group (35.7%, 10/28; 46.4%, 13/28) was significantly higher than that in the hematological tumor group (0.0, 0/13; 0.0, 0/13; P<0.05), while the proportion of patients with intermediate karyotypes (42.9%, 12/28) was significantly lower than that in the hematological tumor group (84.6%, 11/13; P<0.05), the difference was statistically significant. The CR rate (90.0%, 9/10), median OS (not reach) and median RFS (not reach) in the t-APL group were higher than those in the t-AML (without t-APL) group (38.5%, 10/26; 6 months; 8 months; P<0.05). After excluding the effect of t-APL patients, there was no significant difference in the CR rate, median OS and median RFS between the solid tumor group (8; 9 months; not reach) and the hematological tumor group (2; 4 months; 2 months; P>0.05). Univariate analysis showed that the primary tumor belongs to hematological tumor was a common risk factor for OS and RFS in t-AML patients (P<0.10). Conclusions: Compared with patients with t-AML secondary to solid tumors, patients with t-AML secondary to hematological tumors have poorer treatment effects and poorer prognosis. After excluding the effect of t-APL patients, there are no significant differences in the treatment efficacy and prognosis between the two types of t-AML patients.

Ameliorating impact of coenzyme Q10 on the profile of adipokines, cardiomyopathy, and hematological markers correlated with the glucotoxicity sequelae in diabetic rats

BACKGROUND

In diabetes, high blood glucose induces glucotoxicity, resulting in the further damage of pancreatic beta-cells and then precipitating diabetic complications. This study was aimed to investigate the relationship between glucotoxicity with the level of adipokines, diabetic cardiomyopathy, and hematological markers. Moreover, the study examined the potential modulatory effect of coenzyme Q10 (CoQ10) on the aforementioned markers associated with the sequelae of diabetes mellitus.

MATERIAL AND METHODS

Twenty-four male rats were randomly assigned to receive an injection of STZ to induce diabetes (n = 16) or to remain uninduced (n = 8). The hyperglycemic status was induced in fasting rats by single intraperitoneal injection of STZ (45 mg /kg b.w.) dissolved in citrate buffer (pH 4.5). Three days after STZ injection, rats were divided into three groups; Normal control group (A), Diabetic control group (B), and CoQ10- treated diabetic group (C). The group (C) was fed with the basal diet supplemented with 5 g of CoQ10 per kilogram of diet for three weeks after the diabetes induction. After 21 days, the blood and serum samples were taken to conduct biochemical analyses. Blood glucose was determined by Blood Glucose Monitoring System. Adipokines or cytokines were evaluated by ELISA from a serum sample. Cardiac myopathy biomarkers were estimated by UP-Converting Phosphor Immunoassay Analyzer, and hematological parameters were measured by automatic hematology analyzer.

RESULTS

In hyperglycemic rats, the level of fasting blood glucose, and serum level of resistin, omentin, TNF-α, and cardiomyopathy biomarkers significantly increased (P < 0.05). The treatment with CoQ10 significantly decreased the profile of adipokines and cardiomyopathy markers (cardiac enzymes and LPPLA2) in diabetic rats and also reduced glucose levels (P < 0.05). Lymphocyte percentages significantly decreased while significant increases were observed in granulocytes and MID percentages in hyperglycemic rats.

CONCLUSION

Diabetic rats had higher serum levels of adipokines and cardiomyopathy markers. Among the hematological markers, GRA% and MID% increased while LYM% decreased. The profile of adipokines and cardiomyopathy markers improved when CoQ10 was supplemented. The study suggests that CoQ10 may have a beneficial effect on improving diabetic complications.

Impact of occupational heat exposure on selected haematological parameters of bakery workers: A comprehensive study in Ilorin, Kwara State

The Occupational Health and Safety Administration has identified indoor industries at risk of experiencing heat-related illnesses due to the presence of heat-generating appliances; these include bakeries, kitchens, laundries, and furnaces. This study aimed to assess the effects of heat stress on haematological parameters and erythrocyte sedimentation rates (ESR) of bakery workers in Ilorin, Kwara State. It was a cross-sectional study, involving laboratory analysis, which lasted for 3 months. A total of 60 Male and female bakery workers aged between 18 and 65 years with 1 or more years of working experience were recruited for this study. Full blood count estimation was carried out using haematological analyzer (Sysmex-2000) and the ESR was carried out using the Westergren method in the Haematology unit, Kwara State University, Malete. Results were analyzed using SPSS version 20. This study found the bakery workers to have low ESR (2.13 ± 1.28) compared to (10.05 ± 4.95) of the control, the RBC was high (6.708 ± 2.08) compared to (5.46 ± 1.12) of the control group. TWBC was also found to be high (7.425 ± 1.74) compared to (6.95 ± 2.49) of the control population. Findings from this study concluded that working under high temperatures negatively affected the health of bakery workers with reports of heat stress-related symptoms and also affected ESR and haematological parameters. A comprehensive and effective national occupational health and safety program that includes relevant policies, decrees, and proper enforcement is needed to ensure the worker's safety and health both in the formal and the fast-growing informal sectors.

Relationship between tobacco smoking and hematological indices among Sudanese smokers

BACKGROUND

Tobacco Smoking is one of the leading causes of preventable morbidity and mortality in the world. It is well documented that tobacco smoking is risk factor for many diseases like: cancers, chronic respiratory and cardiovascular diseases, and the effects of tobacco smoking on hematological indices gets a little attention: the data is mostly inconsistent regarding the differential of WBCs, a conflicting studies described the effect of smoking on hemoglobin descriptive parameters and a regular monitoring of platelets count in smokers was advised.

OBJECTIVES

The study aimed to evaluate the relationship between tobacco smoking and hematological parameters among Sudanese healthy Smokers at Bahri Town.

METHODS

This was a cross sectional study conducted during 2022 in Bahri town, Khartoum state. A total of 120 male subjects participated in this study. Of them, 60 healthy non-smokers participants (Control), and 60 age matched smokers who were smoking tobacco for a minimum of 1 year. Smokers group was divided into three major sub-groups with each group contains 20 subjects: Cigarettes smokers (CS), Water pipes (Shisha) smokers (WP) and both Cigarettes and water pipes (shisha) smokers (CSWP). Data was collected through questionnaire interviews and laboratory investigation. A sample of Five ml venous blood was taken for Complete blood count testing using Urite 3000 plus semi-automated hematology analyzer. Data were analyzed using SPSS version 25. Assocation between the variables were estimated and p value ≤ 0.05 was considered statistically significant.

RESULTS

Smokers had significantly higher RBCs count (p = 0.017), Hb level (p < 0.001), WBCs count (p = .017), Neutrophils (p < 0.001), MCH (p = 0.029), MCHC (p < 0.001), RDW (p < 0.001), and PDW (p < 0.001) compared to the non-smokers. In contrast, non-smokers had higher MPV (p < 0.001) and MCV (p < 0.001) levels than smokers. Between the non-smokers and different subtypes of the smokers (CS, WP & CSWP), there were significant differences between the subgroups for all hematological parameters except for PLTs and lymphocytes count. CS had lower levels of MCV (p < 0.001), MCHC (p < 0.001), HCT (p = 0.036), and RDW (p < 0.001) compared to the non-smokers, while both cigarette and shisha smokers had the higher levels of neutrophils count (p < 0.001) and PDW (p < 0.001) compared to the non-smokers.

CONCLUSION

Smoking affects hematological parameters; smokers had significantly higher RBCs count, Hb level, WBCs count, Neutrophils, MCH, MCHC, RDW and PDW compared to the non-smoker group. WP smoking caused higher levels of RBCs, Hb, neutrophils, MCH and MCHC. PDW was high in smokers' sub-groups compared to control group, while MPV was lower despite insignificant change In PLTs count.

Physiological Response, Haematology and Stress Condition of Scavenging Chickens in Cement Production Areas

This study investigated the physiological and stress indices of scavenging chickens in LAFARGE and Dangote cement factories located at Ewekoro and Ibese, respectively and respective adjourning communities of Ogun State, Nigeria. One hundred adult scavenging chickens comprising of 25 from each location were used. The birds were caught at night on their perch and kept in furnished cages till the next morning. Data were collected on their rectal temperature, pulse rate, and respiratory rate . Also 5 mL blood was collected through the wing vein of each chicken. Highest (p < 0.05) pulse rate (215.64 beat/minute) and respiratory rate (19.90 breath/minute) were recorded among the chickens at LAFARGE area. Highest (p < 0.05) packed cell volume (28.06%), hemoglobin (4.01 g/dL), monocyte (4.28%) and glucose (256.53 g/dL) were recorded among ones at Ibese (Dangote). White blood cell (6488.89 × 103µL) was highest (p < 0.05) in chickens at Ewekoro (LAFARGE). The study concluded that cement factories infringe on health status of scavenging chickens in the domains. Effective environmental mitigation programme should be put in place for enhanced welfare of the birds.

HEMATOLOGY AND BIOCHEMISTRY REFERENCE INTERVALS FOR REHABILITATED EUROPEAN BADGERS (MELES MELES)

The goal of this study was to establish routine reference intervals (RI) for common laboratory tests for the European badger (Meles meles). Blood samples were collected from 13 female and 11 male adult European badgers in a wildlife rehabilitation facility and used for standard hematology and biochemistry analyses. The established 95% RI (2.5th-97.5th percentile) were determined by either parametric (normally distributed data) or robust (nonnormal data) statistical methods and showed a lower range of variability compared with those reported in previous literature. Sex did not affect any investigated parameters. As the first RI study on free-living European badgers in Italy, these reported hematology and serum chemistry RI provide a set of accurate and reliable laboratory parameters for this species.

Evaluation of postnatal growth, hematology, telomere length and semen attributes of multiple clones and re-clone of superior buffalo breeding bulls

The present study comprehensively evaluates the postnatal growth, hematology, telomere length, and semen attributes of multiple clones and re-clone derived from superior buffalo breeding bulls. To the best of our knowledge, we successfully produced multiple clones and a re-clone of an earlier cloned buffalo bull from an embryo developed from an adult bull's skin-derived cell for the first time. The cloned bulls' growth, blood hematology, plasma biochemistry, and telomere length were all shown to be normal at various stages of development. The bulls were used for semen production after being screened for testicular growth and training. Semen characteristics such as volume, concentration, and initial motility of fresh sperm as well as motility and kinetics characteristics such as straightness (STR), average lateral head displacement (ALH), and beat cross frequency (BCF) of frozen-thawed sperms of the cloned bulls were found to be similar to those of non-cloned bulls, including the donor bulls. Additionally, it was found that cloned bulls' functional sperm attributes, including acrosome intactness, mitochondrial membrane potential, and superoxide anion status, were comparable to those of non-cloned bulls. These characteristics are necessary for sperm to pass through the female reproductive system, penetrate the oocyte, and efficiently fertilize. Finally, this study adds to our understanding of the postnatal development, hematology, telomere length, and sperm characteristics of superior buffalo breeding bulls that have been cloned and re-cloned. The findings provide the groundwork for improving cloning practices, refining reproductive procedures, and optimizing the use of cloned genetic material in animal breeding and conservation.

Hematology in the post-COVID era: spotlight on vaccine-induced immune thrombotic thrombocytopenia and a conceptual framework (the 4P's) for anti-PF4 diseases

INTRODUCTION

Vaccine-induced immune thrombotic thrombocytopenia (VITT) is a life-threatening prothrombotic disorder first identified following the introduction of adenoviral vector vaccines for COVID-19. The condition is characterized by anti-PF4 antibodies and clinically presents with thrombocytopenia and thrombosis often in unusual anatomical sites.

AREAS COVERED

In this review, we discuss the clinical presentation, diagnostic testing, and treatment of VITT. We also review VITT-like syndromes that have been described in patients without previous vaccination. We propose a conceptual framework for the mechanism of anti-PF4 diseases that includes sufficiently high levels of PF4, the presence of a Polyanion that can form immune complexes with PF4, a Pro-inflammatory milieu, and an immunological Predisposition - the 4Ps.

EXPERT OPINION

Significant progress has been made in understanding the characteristics of the VITT antibody and in testing methods that can confirm that diagnosis. Future work should be directed at understanding long-term outcomes, mechanisms of thrombosis, and individual risk factors for this rare but dangerous immune-thrombotic disease.

Herbal inclusions ameliorate effect of heat stress on haematology, proinflammatory cytokines, adipokines and oxidative stress of weaned rabbit does in humid tropics

A study was designed to evaluate the effect of Moringa oleifera, Phyllanthus amarus and Viscum album leaf meal as herbal inclusions to alleviate the detrimental outcomes of heat stress in weaned female rabbits. Forty (40) weaned rabbit does (527.99 ± 10.35 g; 28 days old) were randomly allotted to four dietary groups consisting of Diet 1(control diet; without leaf meal), Diets 2 (supplemented with 10% V. album); 3 (supplemented with 10% M. oleifera) and 4 (supplemented with 10% P. amarus) in an 84 days trial at the peak of heat stress in Southwest Nigeria. At the end of the trial, blood samples were collected to assess physiological responses and oxidative status of the rabbit does. The results obtained revealed that rabbit does were exposed to heat stress; rabbit does fed control diet had higher leucocyte and neutrophil/lymphocyte ratio compared to rabbit does fed on herbal inclusions. The herbal inclusions enhanced oxidative stability of rabbit does by lowering lipid peroxidation and enhancing antioxidant activities during heat stress conditions. Rabbit does fed control-based diet had significantly higher heat shock protein 70, leptin and adiponectin compared to rabbit does on M. oleifera, P. amarus and V. album supplemented diets. The herbal inclusions tend to suppress proinflammatory cytokines in rabbit does during heat stress condition. In conclusion, the herbal inclusions suppress inflammation, adipokines and promotes oxidative stability of rabbit does exposed to heat stress conditions.

HEMATOLOGY AND PLASMA CHEMISTRY COMPARISONS AMONG JUVENILE AMERICAN BLACK BEARS (URSUS AMERICANUS) UNDERGOING REHABILITATION

The American black bear (Ursus americanus) is an opportunistic and adaptable species with high rehabilitation success rates. Injured, ill, and orphaned bears across the southeastern United States are examined and treated at the University of Tennessee College of Veterinary Medicine followed by rehabilitation at Appalachian Bear Rescue (ABR). Hematology and biochemistry reference ranges exist for healthy adult black bears; however, most bears presenting to ABR are young and of variable health status. Thus, further investigation into the difference of blood values at varying ages and presentations is warranted. ABR records from 1996 to 2022 included 106 bears with completed hematology and plasma biochemistry panels (22 paired samples at intake and release, 84 at intake only). Intake-only samples consisted of 12 neonates (<3 mon old), 64 cubs (3-12 mon), and 30 yearlings (1-2 yr). Bears presented as orphaned neonates (22%), orphaned cubs (45%), malnourished yearlings (24%), and injured/ill (9%) during fall (16%), winter (13%), spring (32%), and summer (39%). Changes in hematology and plasma biochemistry results between intake and release included an increase in hematocrit and glucose. Injured/ill bears presented with higher total leukocyte count (WBC), absolute neutrophils (ABS segs), alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatine kinase (P < 0.05). Positive correlation between ALT, AST, proteins, and blood urea nitrogen and negative correlation between absolute lymphocytes and alkaline phosphatase were noted with age. Both WBC and ABS segs were lower during winter (P < 0.05). Understanding what factors affect juvenile black bear blood values improves clinical expectations and evaluation upon intake, clinical evaluation, and treatment.

Impact of Facility Dog and Certified Child Life Specialist Dyad on Children's Pain and Anxiety During Needlestick Procedures in a Pediatric Hematology Oncology Clinic Setting

BACKGROUND

Pediatric Hematology Oncology patients undergo frequent needlestick procedures, often leading to negative outcomes including pain and anxiety. Animal-assisted therapy has been shown to minimize pediatric patient distress; however, its utilization by a Certified Child Life Specialist (CCLS) to reduce patient distress has not been widely studied.

METHODS

Pediatric patients receiving needlesticks in the Hematology Oncology Clinic were enrolled between March 2018 and May 2021. Patients who had scheduled visits when the facility dog was present were assigned to the intervention group. Patients were assigned to the control group if the facility dog was not present. The primary objective was to use the Children's Anxiety and Pain Scale to determine whether the CCLS and facility dog dyad minimized patient pain and anxiety during procedures.

RESULTS

A total of 285 patients, 5 to 17 years of age, were enrolled. One hundred forty-three patients were assigned the intervention and received procedural support from the CCLS and facility dog; 142 patients were assigned the control group and received support from the CCLS only. Patient-reported pain scores were significantly lower among patients who received the intervention ( P =0.033).

CONCLUSIONS

Utilization of a CCLS and facility dog dyad during painful needlestick procedures decreases patient-reported pain compared with utilization of CCLS support alone.

Does circle priming improve smart infusion pump and electronic health record interoperability for chemotherapy in a pediatric hematology/oncology setting?

INTRODUCTION

The objective of this project was to assess the percentage of interoperability compliance within our pediatric hematology/oncology patient care areas for intravenous chemotherapy medications before and after the implementation of circle priming.

METHODS

We conducted a retrospective quality improvement project at an inpatient pediatric hematology/oncology floor and outpatient pediatric infusion center before and after implementation of circle priming.

RESULTS

There was a statistically significant increase in percent interoperability compliance for the inpatient pediatric hematology/oncology floor from 4.1% prior to implementation of circle priming to 35.6% after (odds ratio 13.1 (95% CI, 3.96-43.1), p < 0.001), as well as for the outpatient pediatric infusion center from 18.5% to 47.3%, respectively (odds ratio 3.9 (95% CI, 2.7-5.9), p < 0.001).

CONCLUSION

Implementation of circle priming has significantly increased the percentage of interoperability compliance for intravenous chemotherapy medications in our pediatric hematology/oncology patient care areas.

Classical Hematology Referrals at an National Cancer Institute-Designated Cancer Center: Lessons Learned

PURPOSE

To understand the spectrum and volume of classical hematology (CH) referrals to hematology clinics at a National Cancer Institute (NCI)-designated cancer center (CC) to plan for the delivery of effective and equitable care for this population.

METHODS

One referral office at the Academic CC located in Bexar County, TX, handles all adult hematology referrals. From October 1, 2021, to September 30, 2022, all nonmalignant hematology (MH) referrals were triaged daily to define the category of CH problem. Declined referrals (confirmed at triage that no CH problem was evident) are included as part of this analysis. Electronic consultation (opinion rendered without patient seen) at our CC is available and is not part of this analysis.

RESULTS

One thousand nine hundred forty-five CH referrals were received in the 12-month period. Seventy-six referrals (3.9%) were declined. During the study period, there were 2,289 medical oncology referrals and 779 referrals for MH. CH referrals therefore comprise 39% of all hematology-oncology referrals and 71% of all hematology referrals at the CC. Anemia and thrombotic disorders were the most common categories of the accepted CH referrals at 487 (26%) and 393 (21%), respectively. Video visits were used for 447 of all CH referrals (23%), and the rest were in person.

CONCLUSION

Nearly 40% of all referrals to hematology and medical oncology at our NCI-designated CC are for CH. Effective management of the CH population of patients will allow ideal care for CH problems and also allow cancer-focused care to improve.

Extracranial germ cell tumours: Mature and immature (1990-2015). First report by the South African Association of Paediatric Haematology Oncology (SAAPHO)

BACKGROUND AND OBJECTIVES

Outcomes of rare paediatric teratomas have not previously been reported nor treatment regimens standardised in low- and middle-income settings. We sought to evaluate treatment outcomes of children and adolescents with histologically confirmed extracranial germ cell tumours, both mature teratomas (MT) and immature teratomas (IT) in preparation for the development of the South African national treatment guideline.

METHODS

Retrospective data by folder review were collated from nine South African paediatric oncology units. Kaplan-Meier analysis with Cox regression was performed to determine 5-year overall survival (OS) and prognostic factors.

RESULTS

From January 1990 to December 2015, 60 patients were diagnosed with MTs; 14 males (median age 2 months; interquartile range [IQR]: 0-8.75 months) and 46 females (median age 9 months; IQR: 0-88.5 months). Forty patients were diagnosed with ITs; 10 males (median age less than 1 month; IQR: 0-1.75 months) and 30 females (median age 4.5 months; IQR: 1-162 months). There were high rates of upfront surgical resections in patients with MTs (58/60; 96.6%) and ITs (36/40; 90%), and similarly satisfactory rates of complete resection in patients with both MTs (55/60; 91.7%) and ITs (32/40; 80%). The 5-year OS for the whole group was 85.4%, significantly influenced by stage: Stage I (96.9%), Stage II (100%), Stage III (38.9%) (p < .001 [MT]; p = .013 [IT]). The event-free survival (EFS) ratio for the whole cohort was 78.7%.

CONCLUSIONS

Five-year OS for those with low-stage disease was excellent, but was poorer for patients with advanced disease. The implementation of a national treatment guideline will facilitate the standardising of surgical approaches, indications for chemotherapy and specifications for follow-up to improve survival and to collect more robust late effects data.

Hematology and clinical chemistry in mule foals from birth to two months of age: A preliminary study

In horses and donkeys, age-related changes in hematological and biochemical parameters preclude the use of normal values of adults in the evaluation of foals. This study aimed to obtain data on hematological and biochemical parameters of mule foals from birth up to the second month of life and to assess age-related changes in order to determine if dedicated reference ranges are required in younger animals. Blood samples from seven healthy mule foals were obtained at birth before colostrum consumption, 24 h, 48 h of life, and then weekly until the second month of life. Results were expressed as mean and standard deviation or median, minimum, and maximum values if showing non-gaussian distribution. Kruskal-Walls and Dunn tests were used to verify the differences among sampling times. Significance was set at P < 0.05. Red blood cell count, packed cell volume and hemoglobin decreased from 24 h to one week of age. Mean corpuscular volume and mean corpuscular hemoglobin decreased over the first month. White blood cells increased from birth to seven days of life. Aspartate amino transferase increased while alkaline phosphatase decreased in the first week of life. Urea, creatinine, and lactate decreased, while glucose concentrations increased at 24 h. Ionized calcium and magnesium and total sodium and potassium showed no changes. In mule foals, several laboratory parameters may be the same or intermediate, lower or higher than in equine or donkey foals, but also compared to all other adult species. The preliminary results suggest that for mule foals, age influences hematological and biochemical parameters.