Clinical outcome of pre-operative blood transfusion for sickle cell disease patients in post-operative complications

BACKGROUND

Preoperative blood transfusion for patients with sickle cell disease is a debatable topic and it can be lifesaving. Sickle cell disease patients are at high risk for vaso-occlusive crisis due to the large concentration of sickle hemoglobin (HgbS) in their blood. Despite the current extensive research into this disease, there is still no consensus over whether blood transfusion is a preferable preoperative modality among patients undergoing elective surgical procedures.

METHOD

A retrospective observational study, which enrolled 204 patients with Sickle cell disease who underwent surgery at King Fahad Hospital of the University (KFHU) over the last five years. The primary objective was to determine whether there is evidence that preoperative blood transfusion for SCD patients undergoing surgical procedures will reduce postoperative complications related to SCD.

RESULTS

A total of 204 patients were included, of which 30% had preoperative blood transfusion. Majority of patient 44% had undergone cholecystectomy. On multivariate logistic regression analysis, patients who did not undergo blood transfusion had significantly higher risk to develop post-operative SCD complications (OR=3.07, P value= 0.002). In addition, they had significantly prolonged hospitalization (OR= 2.22, P value= 0.08). In contrast, patients who received blood transfusion had lower risk for developing post-operative SCD related complications (OR=1.87, P value= 0.29), and decrease in the duration of hospitalization by (OR=0.49, P value= 0.045).

CONCLUSION

Our study showed that patients who had not undergo preoperative blood transfusion had higher risk to develop postoperative complications and prolonged hospital stay compared to those who underwent blood transfusion.

Fetal and maternal outcomes after maternal biologic use during conception and pregnancy: A systematic review and meta-analysis

Background

Biologic medications, specifically tumour necrosis factor‐α (TNF‐α) inhibitors, have become increasingly prevalent in the treatment of chronic inflammatory disease (CID) in pregnancy.

Objective

To determine pregnancy outcomes in women with CID exposed to biologics during pregnancy.

Search strategy

PubMed and EMBASE databases were searched through January 1998–July 2021.

Selection criteria

Peer‐reviewed, English‐language cohort, case–control, cross‐sectional studies, and case series that contained original data.

Data collection and analysis

Two authors independently conducted data extraction. A meta‐analysis of proportions using a random‐effects model was used to pool outcomes. Linear regression analysis was used to compare the mean of proportions of outcomes across exposure groups using the ‘treated’ group as the reference category. All studies were evaluated using an appropriate quality assessment tool. The GRADE approach was used to assess the overall certainty of evidence.

Main results

Thirty‐five studies, describing 11 172 pregnancies, were eligible for inclusion. Analysis showed pooled proportions for congenital malformations as follows: treated 0.04 (95% CI 0.03–0.04; I² = 77) versus disease‐matched 0.04 (95% CI 0.03–0.05. I² = 86; p = 0.238); preterm delivery treated 0.04 (95% CI 0.10–0.14; I² = 88) versus disease‐matched 0.10 (95% CI 0.09–0.12; I² = 87; p = 0.250); severe neonatal infection: treated 0.05 (95% CI 0.03–0.07; I² = 88) versus disease‐matched 0.05 (95% CI 0.02–0.07; I² = 94; p = 0.970); low birthweight: treated 0.10 (95% CI 0.07–0.12; I² = 93) versus disease‐matched 0.08 (95% CI 0.07–0.09; I² = 0; p = 0.241); pooled miscarriage: treated 0.13 (95% CI 0.10–0.15; I² = 77) versus disease‐matched 0.08 (95% CI 0.04–0.11; I² = 5; p = 0.078); pre‐eclampsia; treated 0.01 (95% CI 0.01–0.02; I² = 0) versus disease‐matched 0.01 (95% CI 0.00–0.01; I² = 0; p = 0.193). No statistical differences in proportions were observed. GRADE certainty of findings was low to very low.

Conclusion

We demonstrated comparable pregnancy outcomes in pregnancies exposed to biologics, disease‐matched controls and CID‐free pregnancies using the GRADE approach.

Meta‐analysis of 11 172 pregnancies exposed to biologic medications shows no evidence of harm for the fetus or the mother.

Linked article: This article is commented on by Laurine L. van der Slink, pp. 1247 in this issue. To view this minicommentary visit https://doi.org/10.1111/1471-0528.17095.

Gastrointestinal manifestations of COVID-19 in a single center in the Eastern Province of Saudi Arabia

BACKGROUND

Several gastrointestinal (GI) symptoms have been associated with novel coronavirus disease-2019 (COVID-19). Their prevalence and relation to the severity and hospital outcome of COVID-19 have not been well reported in the Middle East and Saudi Arabia. We aimed to examine the GI manifestations of COVID-19 and their association with the severity and hospital outcome of COVID-19 infection.

METHODS

We conducted a retrospective observational study of hospitalized COVID-19 patients who had a positive SARS-COV2 PCR test and were admitted at a university hospital in Saudi Arabia, from March to September 2020. The primary objective of the study was to describe the GI manifestations of COVID-19. The secondary objective was to investigate the association of GI manifestations with severity and outcome of COVID-19 infection.

RESULTS

We included 390 patients, of which 111 (28.5%) presented with GI manifestations. The most common presentation was diarrhea followed by nausea, vomiting, and abdominal pain. Patients without GI manifestations had a higher risk of severe-critical COVID-19 infection evident by the development of lung infiltration in more than 50% of lung fields within 24-48 h, acute respiratory distress syndrome, altered mental status, multiorgan failure, and cytokine storm syndrome (P < 0.05). These patients had a higher mortality rate compared to patients with GI manifestations (P = 0.01). A lower odds of death was seen among patients with GI symptoms (AOR 0.36; 95% CI, 0.158-0.82; P = 0.01).

CONCLUSION

COVID-19 infection presents commonly with GI manifestations. Patients with GI manifestations have less severe COVID-19 disease and lower mortality rates.

Delayed Hemolytic Transfusion Reaction in Sickle Cell Disease: A Case Series

Case series

Patients: Female, 44-year-old • Female, 35-year-old

Final Diagnosis: Delayed haemolytic transfusion reaction with alloimmunization

Symptoms: Fatigue • fever • palpitation • shortness of breath

Medication: —

Clinical Procedure: —

Specialty: Hematology

Gastrointestinal perforation secondary to COVID-19: Case reports and literature review

INTRODUCTION

Corona virus disease-2019 (COVID-19) presents primarily with respiratory symptoms. However, extra respiratory manifestations are being frequently recognized including gastrointestinal involvement. The most common gastrointestinal symptoms are nausea, vomiting, diarrhoea and abdominal pain. Gastrointestinal perforation in association with COVID-19 is rarely reported in the literature.

PATIENT CONCERNS AND DIAGNOSIS

In this series, we are reporting 3 cases with different presentations of gastrointestinal perforation in the setting of COVID-19. Two patients were admitted with critical COVID-19 pneumonia, both required intensive care, intubation and mechanical ventilation. The first one was an elderly gentleman who had difficult weaning from mechanical ventilation and required tracheostomy. During his stay in intensive care unit, he developed Candidemia without clear source. After transfer to the ward, he developed lower gastrointestinal bleeding and found by imaging to have sealed perforated cecal mass with radiological signs of peritonitis. The second one was an obese young gentleman who was found incidentally to have air under diaphragm. Computed tomography showed severe pneumoperitoneum with cecal and gastric wall perforation. The third case was an elderly gentleman who presented with severe COVID-19 pneumonia along with symptoms and signs of acute abdomen who was confirmed by imaging to have sigmoid diverticulitis with perforation and abscess collection.

INTERVENTIONS

The first 2 cases were treated conservatively. The third one was treated surgically.

OUTCOME

Our cases had a variable hospital course but fortunately all were discharged in a good clinical condition.

CONCLUSION

Our aim from this series is to highlight this fatal complication to clinicians in order to enrich our understanding of this pandemic and as a result improve patients' outcome.