[ ISSN : 2573-3680 ]
Blood transfusion can cause some transfusion adverse reactions. In order to understand the incidence of adverse transfusion reactions, we performed a meta-analysis in Chinese hospitals. Of 809 literatures, seven studies involving a total of 211, 050 patients with blood transfusion treatment were included in this meta-analysis. Meta-analysis showed that the total incidence of adverse reactions was 0.4% [95% CI (0.2, 0.9), P < 0.0001]. Further subgroup analysis showed that the incidence of febrile and allergic reactions was 0.2% [95% CI (0.1, 0.5), P < 0.0001] and 0.2% [95% CI (0.1, 0.3), P < 0.0001], respectively. The common blood components caused adverse reactions were red blood cell, plasama, and platelet in clinical practice.
Blood transfusion has become a commonly irreplaceable treatment for clinical rescue. However, due to the potential risk of blood transfusion and adverse reactions, transfusion safety has become the focus of global concern [1,2]. Common transfusion adverse reactions have been reported to include fever, allergic reactions, and hemolytic reactions in China. Other adverse reactions might occur such as fluid overload, lung injury, destruction of red blood cells, graft-versus-host disease, infections, and complications of massive transfusion so on. However, there lacks a systematic reviews to clarify the incidence of adverse transfusion reactions. Therefore, we performed a metaanalysis in Chinese hospitals.
Inclusion and exclusion criteria
The included literatures were the observational studies. The subjects were the patients who received a blood transfusion therapy. The study must report the incidence of adverse reactions, and the retrieval date was set between January 1, 2014 and December 31, 2014. Reviews or commentaries, duplicated literatures, and case reports were excluded in this study. We used the preferred reporting items for systematic review and meta-analyses (PRISMA) statements [3,4] as the guidelines of this present meta-analysis.
Retrieval strategy and data extraction
We searched the Chinese Biomedical Literature Database (CBM), Wanfang Database, Chinese Scientific Journals Full-text Database (VIP), China National Knowledge Infrastructure (CNKI), PubMed and EMBASE database by computer. Data extraction and quality assessment was independently performed by two researchers and any controversies were resolved by consensus.
Statistical analysis
Statistical calculations were performed using Meta Analyst version 3.13 (Boston, MA, USA). Heterogeneity among the studies was evaluated by the Cochran’s chi-squared test (Cochran’s Q) and the I2 statistics. Assessments of heterogeneity determined to adopt a random effects model or a fixed effects model. In this study, the Der Simonian–Laird method was used. A Begg’s funnel plot was used for the assessment of publication bias.
Of 809 literatures, seven studies involving a total of 211,050 patients with blood transfusion treatment were included in this metaanalysis [5-9]. The incidences and types of adverse reactions were seen (Table 1). The distributions of adverse reactions in each of blood components were presented in (Table 2). The results revealed that the common blood components caused adverse reactions were red blood cell, plasama, and platelet in clinical practice.
Table 1: The incidences and types of adverse reactions in this meta-analysis.
Table 2: The distributions of adverse reactions in each of blood components.
Meta-analysis showed that the total incidence of adverse reactions was 0.4% [95% CI (0.2, 0.9), random effect model, P < 0.0001] (Figure 1). Further subgroup analysis showed that the incidence of febrile and allergic reactions was 0.2% [95% CI (0.1, 0.5), random effect model, P < 0.0001] and 0.2% [95% CI (0.1, 0.3), random effect model, P < 0.0001] (Figure 2 and Figure 3), respectively. The asymmetry funnel plot revealed a publication bias occurred in this study (Figure 4).
Figure 1: The meta-analysis of the overall incidence of adverse reactions.
Figure 2: The meta-analysis of the pooled incidence of febrile reactions.
Figure 3: The meta-analysis of the pooled incidence of allergic reactions
Figure 4: The funnel plot of this meta-analysis.
perform the meta-analyses of these effects. This meta-analysis showed that the total incidence of adverse reactions in China was 0.4% [95% CI (0.2, 0.9)]. There only found one case with hemolytic reaction in this meta-analysis. Further subgroup analysis showed that the adverse reactions were febrile reactions and allergic reactions. The common blood components caused adverse reactions were red blood cell, plasama, and platelet in clinical practice, which might be related to the frequencies of these components. However, due to lack of the available relevant data, we couldn’t give further classifications in this study.
In addition, the asymmetry funnel plot revealed a publication bias occurred in this study. The safety of blood and blood products should be overseen by Haemovigilance according to the requests of World Health Organization (WHO). In the UK this data is collected by an independent organization (Serious Hazards of Transfusion). Therefore, we believed that China should take more effective measures to enforce the surveillance of adverse effects of transfusions of blood products. We proposed that China should enforce the supervision on the clinical use of blood and build up a Haemovigilance information platform by internet in the future.
3. Tang RT. Investigation of adverse effects in 36 cases with transfusion [J]. Lin Chuang Xue Ye Xue Za Zhi. 2014, 6: 1057-1058.
4. Yao ZJ, Chen HB, Zheng BB, Yang DG. 208 cases of adverse transfusion reactions in Hainan province. Lin Chuang Xue Ye Xue Za Zhi. 2014;
5: 888- 889. 5. Lu GQ, He YY, Shen HY, Yu HD, He YL. Transfusion adverse reaction investigation of 12406 cases of blood transfusion [J]. Zhongguo Wei Shen Jian Yan Za Zhi. 2014; 22: 3313-3314.
6. Dong K. Retrospective analysis of clinical transfusion adverse reactions and intervention measures in 49 blood transfusion cases [J]. Henan Yi Xue Yan Jiu. 2014; 9: 111-113.
7. Ji H. Retrospective study of 131 cases of clinical transfusion adverse reactions.Zhongguo She Qu Yi Shi. 2014; 30: 138-140.
8. Shen L, Wu XY. Analysis and prevention of adverse drug reactions in patients with [J]. Zhongguo Gao Deng Yi Xue Jiao Yu. 2014; 10: 127-142.
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Gao Y, Li Q, Gao Z, Zhu Y, Zhu C, Sun Y et al. Meta-Analysis of Incidence of Adverse Transfusion Reaction in Clinical Cases in China. SM J Clin Med. 2015; 1(1): 1005.
The purpose of this statement is none other than to highlight the importance of ethical standards and quality required in basic and applied research currently being done so we can subsequently inform health care professionals of new developments that are taking place in this area.
Ma. Esperanza Rodríguez-van Lier*
Chemotherapy is commonly used in cancer treatment. So far, chemotherapy agents can be categorized into three types: classical chemotherapeutic drugs, molecular target agents and cellular machineries target drugs.
Ziyou Wang1,2 and Zunnan Huang1,2*
Background: CT scanning remains one of the most routinely used diagnostic tools in a setting of Interstitial Lung Disease (ILD). New and improved technologies, such as High Resolution Computer Tomography (HRCT) have revolutionized the quality of imaging, leading to a prominent increase in number of incidental findings that may or may not be of any clinical significance. The aim of this study was to evaluate the prevalence of incidental findings on thoracic CT and their clinical significance.
Methods: Retrospective analysis was conducted on a cohort of 84 patients referred to our academic center as cases of ILD. Patients were referred for further evaluation between January 2000 and January 2014 and were followed over the disease course. CT scans were done annually as part of clinical management and patients were screened for any incidental findings. All incidental findings were reviewed, recorded in a clinical database and followed up on subsequent visits.
Results: 25 (30%) patients were found to have incidental findings. Liver abnormalities were found in 12 (14.29 %) patients. 11(13.10 %) patients were reported to have coronary artery calcifications. 5 (5.95 %) and 3 (3.57%) patients had thyroid abnormalities and renal cysts, respectively. A malignant lesion was found in 1 patient each in liver and thyroid abnormality subgroup.
Conclusion: Incidental findings are common on thoracic CT scans providing valuable and unexpected findings which warrant investigation by health care providers to exclude malignant processes.
Sonu Sahni1,2*, Sameer Verma1,2, Reeju S Thomas1 , Barbara Capozzi3 and Arunabh Talwar1,2
Hepatitis C Virus infection (HCV) is an increasing public health concern with an estimated 184 million people infected worldwide and approximately 350.000 yearly deaths from HCV-related complications.
Nesrine Gamal and Pietro Andreone*
We report a case of large cell undifferentiated lung carcinoma in a middle aged patient with previously treated tuberculosis and scarring. 20 pack years of smoking history was noted. He presented with metastasis at multiple sites including trochanter, liver and acute bilateral lateral rectus palsy. Chest radiography showed fibrosis of right upper zone with homogenous opacity. Sputum examination for AFB was negative. Computerized tomography of the thorax showed an irregular heterogeneously enhancing mass involving right upper lobe with cavitation, necrosis along with lymph node involvement and the erosion of the 4th rib with liver metastasis. Radiography of hip joint was suggestive of lesser trochanteric metastasis. MRI brain was suggestive of mass at base of brain in parasellar area. Fine needle aspiration cytology and CT guided biopsy confirmed undifferentiated large cell carcinoma of lung. Tuberculosis and smoking may increase the risk of lung scarring and malignancy and pulmonary scarring may be associated with increased lung carcinoma in ipsilateral lung. Clinician needs to be more sensitive to look for malignancy association particularly in patient with or previously treated for tuberculosis and even more emphasis to be laid if scarring of lung is observed.
Sreenivasa Rao Sudulagunta1 *, Shyamala Krishnaswamy Kothandapani2 , Mahesh Babu Sodalagunta3 , Hadi Khorram2 , Mona Sepehrar4 and Zahra Noroozpour1
Systemic Sclerosis (SSc) is a connective tissue disease characterized by fibrosis of the skin and internal organs, pronounced alterations in the microvasculature and frequent cellular and humoral immunity abnormalities. The rheumatic involvement of SSc is polymorphic and can reveal the disease or may appear during the course of its progression. Musculoskeletal involvement is dominated by non specific arthralgia, polyarthritis, and bony resorption especially acro-osteolysis. The diagnosis of these rheumatic manifestations is generally based on x rays examination. Musculoskeletal involvement in SSc is generally relieved with Non Steroidal Anti-Inflammatory Drugs (NSAID) or low dose of corticotherapy. The immunosuppressive therapy is used in corticoid-resistant or corticoid-dependent forms such us méthotrexate. The aim of our review is to presents an overview of the different osteoarticular and muscular involvement in SSc, their diagnosis and management.
Nessrine Akasbi*, Fatima Ezzahra Abourazzak and Taoufik Harzy
Sedigheh Mirhashemi1 , Mohammad Hosein Kalantar Motamedi1 *, Amir Hossein Mirhashemi2 and Hamid Reza Rasouli1
We encountered two autopsy cases of huge cardiomegaly with over 1000g in weight. Histochemical characteristics were examined using conventional staining including HE and Azan stains and immunohistochemical staining using antibodies against Complement Component 9 (CC9), RNA Binding Protein Motif 3(RBM3), Endothelial Type NO Synthase (eNOS) and Hypoxic Inducible Factor1α (HIF1). The reactive area with anti CC9 antibody, which presumed to be a marker of hypoxic change of myocardium, overlapped with eosinophilic area by HE and basophilic one by Azan. Although the reactive area with anti CC9 antibody showed relatively weak in the cytoplasm by anti eNOS antibody and no in the nucleus of cardiocytes with anti RBM3 antibody, outside of the reactive area with anti CC9 antibody there were intensive reactivity with anti eNOS antibody in cytoplasm and in a nucleus with anti RBM3 antibody. Anti HIF1 antibody showed weak reactivity with cytoplasm of endocardial cardiocytes and no with cytoplasm of cardiocytes in another area. The results obtained from the present cases revealed that the hypoxic change was equivalent even though the cause of cardiomegaly was deferred between two cases, and conventional staining such as HE and Azan utilized to detect hypoxic change in the heart and immunohistochemical studies seemed to be a useful tool for clarifying the cascade of hypoxic changes in the myocardium.
Satoshi Furukawa1,2*, Mayumi Kataoka1 , Satomu Morita1,2, Akari Uno2 , Masahito Hitosugi2 , Hiroshi Matsumoto1,3 and Katsuji Nishi1,2
A 45-year-old woman with multiple sclerosis was admitted to our hospital after out of hospital cardio-pulmonary resuscitation. The first ECG showed ventricular fibrillation. Following direct current defibrillation and mechanical reanimation, spontaneous circulation was restored and the ECG unremarkable without any signs of ischemia. Coronary angiography showed unobstructed coronary arteries Figure 1, (Panel A). Left ventriculography revealed apical wall obstruction, suggestive of apical aneurysm (Panel B, supplementary videos). Transthoracic echocardiography and Cardiac Magnetic Resonance Imaging (CMR) eventually lead to the diagnosis of a rare case of Apical Hypertrophic Cardiomyopathy (AHC) with ace of spades-form (Panel C,D). The patient underwent Cardioverter-Defibrillator Implantation (ICD) and amiodarone medical therapy for secondary prophylaxis. Patient’s family history and screening for HCM were unsuspicious.
Wiedemann S# *, Heidrich FM# , Speiser U and Strasser RH
We present the case of a 23-year-old female who was 23 weeks pregnant and presented to the emergency room of our Obstetric Department in nausea and vomiting that had been worsening over the course of 2 months with loss of eight kilograms in clinical presentation compatible with hyperemesis.
Elisa Picardo1*, Marco Mitidieri1, Marco Bozzaro2, Roberto Altieri2, Carlo Carmazzi1 and Saverio Danese1