Background Hip fracture patients often experience surgical site infections (SSIs) as a major infectious complication after undergoing total hip arthroplasty (THA), which can lead to extended hospital stays, increased mortality, and higher healthcare costs. This study aimed to determine the incidence of SSI and identify the risk factors associated with it after THA. Objective This study aimed to explore the correlation between blood transfusion along with other factors and the occurrence of SSIs in postoperative patients who underwent THA for transcervical femoral neck fractures. Methods We conducted a retrospective analysis by reviewing the medical records of patients aged 60-80 years who underwent surgery for hip fractures at the Unidad Médica de Alta Especialidad Hospital de Traumatología y Ortopedia No. 21 in Monterrey, Mexico, between January 2020 and January 2021. We analyzed potential risk factors such as age, sex, transfusion necessity, preoperative hemoglobin levels, history of diabetes mellitus, arterial hypertension, and end-stage chronic disease. Data are presented as numbers and percentages, and statistical analyses were performed using IBM SPSS Statistics for Windows, Version 28.0 (Released 2021; IBM Corp., Armonk, New York, United States). Results The study included 87 patients, of whom 55 (63%) were women with an average age of 73 years. SSIs were identified in 12 (13.8%) patients. Among those with infections, nine (75%) had a history of blood transfusion (p=0.05). Diabetes, hypertension, and chronic kidney disease also increased the risk for infection. There was no association with gender, age, American Society of Anesthesiologists (ASA) risk, and preoperative hemoglobin. Conclusions We found a heightened risk of SSI in patients with a history of blood transfusions, emphasizing the need for careful consideration and monitoring during the perioperative period. Additionally, patients with comorbidities such as diabetes, hypertension, and chronic kidney disease were more susceptible to SSI, underscoring the importance of preoperative assessment and targeted preventive measures. Further research and collaboration are needed to refine strategies for mitigating SSI risk factors and optimizing healthcare resource utilization.

This report of two cases confronts the longstanding perception of Sickle Cell Trait (SCT) as a clinically benign condition, highlighting its complex and severe clinical manifestations, particularly in the context of blood loss anemia and vaso-occlusive crises (VOCs). The hallmark of sickle cell disease is the severe pain caused by acute vaso-occlusion of the microvasculature that leads to bone marrow infarction. We report two cases of patients with SCT and severe anemia in the setting of blood loss secondary to uterine fibroids subsequently causing VOCs with likely bone sequestration. The occurrence of VOCs in SCT, while infrequent, can be serious and demands a high index of suspicion, particularly when patients appear in significant distress and cardiac or vascular etiologies are ruled out as a source. Reversal of anemia in this case provided quick resolution to symptoms, and we recommend other clinicians not disregard a differential of VOC in SCT carriers, and urge to treat patients as they would if they had sickle cell disease. This report challenges the conventional view of SCT as a condition of clinical benignity, calling for a recalibration in the clinical understanding, management strategies, and focus on this genetic trait under similar circumstances.

OBJECTIVE: To investigate the incidence of preoperative abnormal iron status and its association with packed red blood cell (PRBC) transfusion, postoperative major complications, and new onset of clinically significant disability in patients undergoing elective cardiac surgery.
METHODS: A prospective, observational multicenter cohort study.
METHODS: Three cardiac surgical centers in the Netherlands between 2019 and 2021. Recruitment was on hold between March and May 2020 due to COVID-19.
METHODS: A total of 427 patients aged 60 years and older who underwent elective on-pump cardiac surgery.
RESULTS: The primary endpoint was a 30-day PRBC transfusion. Secondary endpoints were postoperative major complications within 30 days (eg, acute kidney injury, sepsis), and new onset of clinically significant disability within 120 days of surgery. Iron status was evaluated before surgery. Abnormal iron status was present in 45.2% of patients (n = 193), and most frequently the result of iron deficiency (27.4%, n = 117). An abnormal iron status was not associated with PRBC transfusion (adjusted relative risk [ARR] 1.2; 95% CI 0.9-1.8: p = 0.227) or new onset of clinically significant disability (ARR 2.0; 95% CI 0.9-4.6: p = 0.098). However, the risk of postoperative major complications was increased in patients with an abnormal iron status (ARR 1.7; 95% CI 1.1-2.5: p = 0.012).
CONCLUSIONS: An abnormal iron status before elective cardiac surgery was associated with an increased risk of postoperative major complications but not with PRBC transfusion or a new onset of clinically significant disability.

Sickle cell disease (SCD) is a chronic and prevalent hemoglobin disorder with various manifestations and complications depending on the organs involved. Red cell transfusion either simple or exchange is crucial due to its prophylactic and therapeutic roles. We present a case showing serologic discrepancy between the red cells phenotype and the developed alloantibodies to emphasize the crucial role of molecular testing in SCD patients requiring chronic blood transfusion.

Introduction  The current reported mortality rate for elderly neck of femur fractures (eNOFF) is relatively high in the UK. eNOFF patients commonly suffer from associated cardiovascular co-morbidities and tend to have fragile physiological states and poor physiological reserves. Although some studies have shown a potential link between blood transfusion and mortality in eNOFF patients, there is no general consensus on this matter. Therefore, our study aims to explore the possible association between blood transfusion and length of hospital stay (LOHS) as well as short- and long-term mortality rates in eNOFF patients by reviewing the practice of blood transfusion. Methods  This retrospective study was conducted at Wrexham Maelor Hospital, which is part of the Betsi Cadwaladr University Health Board (BCUHB), Wales. The study included patients who were 65 years of age or older and presented with neck of femur fractures. Only patients who required surgical intervention were included, and those managed non-operatively were excluded from the study. The statistical analysis was performed using IBM SPSS Statistics for Windows, Version 25.0 (IBM Corp., Armonk, New York, United States). Furthermore, unpaired t-tests and log-rank (Mantel-Cox) tests were performed to compare the groups that received blood transfusions.  Results  During the study period, a total of 501 eNOFF patients were included in the primary cohort of the study, with a mean age of 81 years (ranging from 65 to 102). The majority of the patients were female (n=340). Of the 501 patients, 79 (15.8%) received a blood transfusion during their treatment. Around 52.9% of the eNOFF patients were categorized as American Society of Anesthesiologists (ASA) III, but there was no statistically significant difference in the requirement of blood transfusion between patients in ASA III, II, and IV categories, as compared to ASA I. Additionally, the mean time to surgery was higher in patients who received a blood transfusion (35.8 hours), and this difference was statistically significant (p=0.035). Moreover, the average LOHS after surgery for eNOFF was longer in patients who needed peri-operative blood transfusion (22 days), and this difference in the means was statistically significant (p=0.022). At the one-year post-surgery mark, mortality was higher in the transfused group (33%), and long-term five-year mortality rates were also higher in this group (63.2%).  Conclusion  Peri-operative blood transfusion may confer certain benefits in the management of eNOFF ptients. However, it should not be regarded as a panacea for improving long-term outcomes. The decision to administer blood transfusion must be made on a case-by-case basis, with careful assessment of individual clinical indications, and the potential risks and benefits taken into consideration. To achieve optimal clinical outcomes, close monitoring and follow-up of eNOFF patients, both in the short-term and long-term, are essential.

Transfusion-related acute lung injury (TRALI) is potentially life-threatening adverse reaction associated with blood transfusion and can induce perioperative pulmonary secretion. TRALI that develops during cardiopulmonary bypass (CPB) may be difficult to detect; however, the pathophysiology might manifest as derangements in CPB operations. A 79-year-old man was scheduled to undergo partial replacement of the aortic arch with CPB. Two units of red blood cells were loaded into the priming solution. Although the vital signs, including oxygenation, remained stable in the prebypass period, perfusionists noticed a decreasing trend in the venous reservoir level early in the CPB operations. The trend continued even during circulatory arrest with selective cerebral perfusion, resulting in the termination of the modified hemofiltration. Surgical procedures were accomplished uneventfully; however, a large amount of fluid was required to maintain the minimal reservoir level and CPB flow. The total fluid balance during CPB was +8,233 mL, which was quite unusual in our practice. When 800 mL of massive pulmonary secretion was detected before CPB withdrawal, the etiology could not be determined simultaneously; nonetheless, systemic vascular hyperpermeability was speculated to be the underlying pathophysiology. Our therapeutic approach following the treatment of acute respiratory distress syndrome contributed to halting the deterioration of lung injury. Although the pneumothorax developed on the first postoperative day, the patient was treated with the insertion of a chest drainage tube. Subsequently, the patient had a good course and was discharged without respiratory complications. In conclusion, massive pulmonary secretion, probably due to TRALI type II, was associated with derangements in CPB operations. Prompt identification of the underlying pathophysiology and appropriate intervention is crucial.

BACKGROUND: β-thalassemia major (β-TM) is an inherited autosomal recessive disorder manifested by the hemoglobin β chain synthesis alteration. It is a lifelong illness with a scope of a wide range of complications. Many kinds of literature evaluated the effect of Ramadan intermittent fasting (RIF) on different medical conditions. However, there are no precise guidelines regarding its effect on patients with β-TM.
METHODS: A retrospective cohort study was conducted on β-TM patients who visited the hereditary blood disorder center at Al Karama Teaching Hospital in Baghdad. Accordingly, six parameters were used to evaluate the effect of RIF on β-TM patients before, during, and after Ramadan. These parameters include hemoglobin level, frequency of transfusion, aspartate aminotransferase (AST) level, alanine aminotransferase (ALT) level, left ventricular ejection fraction % (EF%), and spleen size. All of these details, including the demographic characteristics of age, gender, history of splenectomy, and body mass index (BMI) were retrieved from the patient\'s medical records after confirming their fasting through one-to-one interviews. This study aimed to fill the gap and investigate the possible effect of RIF on the severity of β-TM.
RESULTS: A total of 184 β-TM patients were enrolled in this study. The mean duration of fasting was 25.2±2.18 days. More than half (110) of the patients were females (59.8%). Whereas, the mean age was 24.8±3.5 years. One-third of the patients (65) had a splenectomy (35.3%) and more than two-thirds had normal BMI. The initial parameters used to score the severity of β-TM were evaluated separately. As a result, the hemoglobin level remained steady without any statistical significance during the three months. In addition, the frequency of blood transfusion and the spleen size carried the same result. Although the lowest median and range of liver enzymes were recorded during Ramadan, they were statistically insignificant compared to pre and post-fasting. Moreover, the left ventricular EF% was insignificant regardless of the patient\'s history of heart disease.
CONCLUSIONS: This study revealed that RIF does not seem to affect the severity of β-TM if the patients proceed with fasting. However, further studies in more countries with a bigger sample size are recommended to confirm these findings.

Background Total hip arthroplasty (THA) is the most successful orthopedic elective surgical procedure for end-stage hip arthritis. THA is linked with significant blood loss, ranging from 1,188 to 1,651 mL, and a transfusion rate of 16-37%, which frequently results in postoperative blood transfusions. Postoperative blood transfusions can be avoided by using autologous blood transfusion, intraoperative blood saving, local anesthetic, hypotensive anesthesia, and antifibrinolytic medications such as tranexamic acid (TXA) administration. Methodology A double-blinded, placebo-controlled, randomized, controlled study was conducted with three prospective groups to investigate the efficacy of topical and systemic routes of a single intraoperative dose (1.5 g) of TXA. Patients were recruited from our center between October 2021 to March 2022 who were undergoing primary total hip replacement. Estimated blood loss was calculated and compared in groups, and a p-value of <0.05 was taken as significant. Results A total of 60 patients were recruited in our study. Estimated blood loss was similar in both treatment groups, 816.8 ± 219.9 mL in the systemic TXA group and 775.5 ± 107.2 mL in the topical TXA group. The placebo group had 1,066.3 ± 150.4 mL estimated blood loss, which was significantly higher compared to the treatment groups. Conclusions Administration of TXA (1.5 g) significantly lowers blood loss without increasing problems, which can eliminate concerns about intravenous TXA use. TXA reduces blood loss by 270 mL on average.

This article presents the near-infrared spectroscopy (NIRS) dataset of cerebral (StO2c) and splanchnic (StO2s) oxygenation in 29 stable premature infants admitted to a tertiary neonatal intensive care unit who received elective packed red blood cell transfusion (PRBCT) to treat anemia of prematurity. StO2c and StO2s data were prospectively recorded continuously from at least 4 hours before the beginning of PRBCT until 24 hours after its completion, using a 4-wavelength near-infrared spectroscopy (NIRS) monitor (FORE-SIGHT® absolute cerebral oximeter, CASMED, Branford, Connecticut, 06405 USA). StO2 data were downloaded as an analog output at a sampling rate of 1000Hz and aligned along the time axis in LabChart reader format (.adicht files) using a PowerLab data acquisition system [1] (PowerLab®, ADInstruments, Sydney, Australia). The .adicht files were then converted into .mat file format using a Python script (PythonTM version 3.7.3 [2]) and resampled at 1Hz for faster processing. Data that could not be physiologically explained (e.g., the absence of variability, [3] a 30% step change in StO2 between two subsequent data points for StO2[4]), as well as the data during the period of \'cares\' were presumed to be artefactual and were replaced with \'NaN\' or \'Not a Number\' which is recognised by Matlab [5] (MATLAB 9.3, The MathWorks, Inc., Massachusetts, United States) and ignored for all subsequent processing while maintaining the correct time point of the StO2 signals. The data were then exported into Microsoft Excel format. The splanchnic cerebral oxygenation ratio (SCOR) was calculated as the ratio of StO2s/StO2c. A 4-hour mean pre-transfusion values (StO2s 0, StO2c 0, SCOR 0) and post-transfusion hourly mean values (1-28) were determined. Secondary data were derived from a Mixed Models for Repeated Measures (MMRM) analysis with the time point fitted as a fixed effect and the infant fitted as a random effect. The MMRM was used to perform paired comparisons between pre-transfusion and each of the post-baseline values. This article only provides the NIRS data. The secondary data and demography can be found in the article \"Splanchnic-Cerebral Oxygenation Ratio associated with Packed Red Blood Cell Transfusion in preterm infants\", published in Transfusion Medicine. [6] The data will be of use to researchers in neonatology, transfusion medicine, and physiology to understand changes in cerebral and splanchnic oxygenation associated with PRBCT. Data collection, processing, and analysis can be remodelled in larger multicentric randomised controlled studies to evaluate the effect of transfusion and feeding on transfusion-associated necrotising enterocolitis. The data are also helpful to explore the autoregulatory behaviour of the brain and gut when the oxygen content of blood is increased by administering PRBCT.

BACKGROUND: Splanchnic-cerebral oxygenation ratio (SCOR), the ratio of splanchnic tissue oxygen (StO2 s) to simultaneously measured cerebral tissue oxygen (StO2 c), has been described as a surrogate to detect impaired splanchnic oxygenation associated with hypoperfusion status such as necrotizing enterocolitis. This concept is based on the presumption that any change in SCOR indicates a corresponding change in splanchnic tissue oxygenation as the numerator, whereas cerebral tissue oxygenation as the denominator remains stable. However, it is questionable to utilise this concept to detect splanchnic oxygenation changes in the context of packed red blood cell transfusion (PRBCT).
OBJECTIVE: The current study examines the contribution of both cerebral and splanchnic oxygenation components to PRBCT-associated SCOR changes in preterm infants.
METHODS: Prospective cohort study.
METHODS: Neonatal intensive care.
METHODS: Hemodynamically stable infants: Gestation <32 weeks; birth weight <1500 g; postmenstrual age <37 weeks: tolerating ≥120 ml/kg/day feed volume.
METHODS: PRBCT at 15 ml/kg, over 4 h.
METHODS: Transfusion-associated changes were determined by performing mixed models for repeated measures analysis between the 4-h mean pre-transfusion values (SCOR 0, StO2 s 0, and StO2 c 0) and the post-transfusion hourly mean values for the next 28 h (SCOR 1-28, StO2 s 1-28, and StO2 c 1-28). Dunnett\'s method was used to adjust for the multiplicity of the p value.
RESULTS: Of 30 enrolled infants 14 [46.7%] male; median [IQR] birth weight, 923 [655-1064] g; gestation, 26.4 [25.5-28.1] weeks; enrolment weight, 1549 [1113-1882] g; and postmenstrual age, 33.6 [32.4-35.0] weeks, one infant was excluded because of corrupted NIRS data. With the commencement of PRBCT, SCOR demonstrated a downward trend throughout the study period. This drift was associated with an increasing StO2 c trend, while StO2 s remained unchanged throughout the study period.
CONCLUSIONS: PRBCT-associated SCOR decrease suggests improvement in cerebral oxygenation rather than worsening splanchnic oxygenation. Our study underlines that it is necessary to determine individual components of SCOR, namely cerebral and splanchnic StO2 to understand SCOR changes in the context of PRBCT.