Transfusion reactions in newborns

Transfuzija krvnih pripravaka je siguran i učinkovit postupak liječenja. Međutim, transfuzija može imati i neželjenih posljedica. Za razliku od odraslih i starije djece, u novorođenčadi se rijetko javljaju imunološke transfuzijske reakcije, jer oni izuzetno rijetko stvaraju aloprotutijela zbog nezrelosti imunološkog sustava. Stoga su imunološke transfuzijske reakcije koje se u njih jave češće posljedica pasivnog prijenosa protutijela transfuzijom krvnog pripravka koji sadrži plazmu, nego protutijela koje je stvorilo dijete. Metaboličke komplikacije, koje su rijetke u odraslih, mnogo su češće u novorođenčadi zbog nezrelosti njihovih organskih sustava. Nedonoščad je osobito rizična za nastanak metaboličkih komplikacija, ona zbog nezrelosti mogu imati poteškoće u učinkovitom metaboliziranju različitih tvari što se nalaze u antikoagulantnim i aditivnim otopinama koje se primjenjuju za pohranu krvnih pripravaka. Rizik za prijenos hepatitisa i AIDS-a transfuzijom krvih pripravaka koji su testirani na biljege ovih zaraznih bolesti danas je vrlo nizak. Na žalost, još i sad postoji mogućnost prijenosa nepoznatih mikroorganizama transfuzijom krvi. Tijekom i nakon svake transfuzije treba pratiti primatelja zbog pojave simptoma i znakova koji bi upućivali na eventualnu transfuzijsku reakciju. Donošenje odluke o transfuzijskom liječenju bolesnika, bez obzira je li riječ o novorođenčetu, starijem djetetu ili odrasloj osobi, zahtijeva da se uz sve prednosti razmotre i moguće posljedice tranfuzijskog liječenja.The transfusion of blood components is a safe and life-saving procedure. However, it may lead to an adverse outcome. Some of the more frequent acute immunologic transfusion reactions that are seen in older children and adults, such as febrile or allergic reactions, are rarely reported in the newborn. When these reactions do occur, they are usually the result of passively acquired antibodies infused into a relatively small plasma volume, rather than of antibodies produced by the infant. Newborns, on the other hand, may be more vulnerable to metabolic or physiologic complications as a result of the immature nature of their organ systems. The immature development of several organ systems in the premature infant has led to many concerns relating to the infant\u27s ability to efficiently metabolize various compounds present in the anticoagulants and preservatives used for the storage of blood components. The risks for transfusion-related infection from screened donations for hepatitis B virus, hepatitis C virus and human immunodeficiency virus are today very low. Unfortunately, the potential still exists for previously unknown microorganisms to be transmitted via transfusion. All transfusions should be carefully monitored, and adverse reactions to blood components should be appropriately investigated. The decision to transfuse a patient, whether the patient is a newborn, an older child, or an adult, requires considering both the risks and the intended benefits of the transfusion

Transfusion reactions in newborns

Transfuzija krvnih pripravaka je siguran i učinkovit postupak liječenja. Međutim, transfuzija može imati i neželjenih posljedica. Za razliku od odraslih i starije djece, u novorođenčadi se rijetko javljaju imunološke transfuzijske reakcije, jer oni izuzetno rijetko stvaraju aloprotutijela zbog nezrelosti imunološkog sustava. Stoga su imunološke transfuzijske reakcije koje se u njih jave češće posljedica pasivnog prijenosa protutijela transfuzijom krvnog pripravka koji sadrži plazmu, nego protutijela koje je stvorilo dijete. Metaboličke komplikacije, koje su rijetke u odraslih, mnogo su češće u novorođenčadi zbog nezrelosti njihovih organskih sustava. Nedonoščad je osobito rizična za nastanak metaboličkih komplikacija, ona zbog nezrelosti mogu imati poteškoće u učinkovitom metaboliziranju različitih tvari što se nalaze u antikoagulantnim i aditivnim otopinama koje se primjenjuju za pohranu krvnih pripravaka. Rizik za prijenos hepatitisa i AIDS-a transfuzijom krvih pripravaka koji su testirani na biljege ovih zaraznih bolesti danas je vrlo nizak. Na žalost, još i sad postoji mogućnost prijenosa nepoznatih mikroorganizama transfuzijom krvi. Tijekom i nakon svake transfuzije treba pratiti primatelja zbog pojave simptoma i znakova koji bi upućivali na eventualnu transfuzijsku reakciju. Donošenje odluke o transfuzijskom liječenju bolesnika, bez obzira je li riječ o novorođenčetu, starijem djetetu ili odrasloj osobi, zahtijeva da se uz sve prednosti razmotre i moguće posljedice tranfuzijskog liječenja.The transfusion of blood components is a safe and life-saving procedure. However, it may lead to an adverse outcome. Some of the more frequent acute immunologic transfusion reactions that are seen in older children and adults, such as febrile or allergic reactions, are rarely reported in the newborn. When these reactions do occur, they are usually the result of passively acquired antibodies infused into a relatively small plasma volume, rather than of antibodies produced by the infant. Newborns, on the other hand, may be more vulnerable to metabolic or physiologic complications as a result of the immature nature of their organ systems. The immature development of several organ systems in the premature infant has led to many concerns relating to the infant\u27s ability to efficiently metabolize various compounds present in the anticoagulants and preservatives used for the storage of blood components. The risks for transfusion-related infection from screened donations for hepatitis B virus, hepatitis C virus and human immunodeficiency virus are today very low. Unfortunately, the potential still exists for previously unknown microorganisms to be transmitted via transfusion. All transfusions should be carefully monitored, and adverse reactions to blood components should be appropriately investigated. The decision to transfuse a patient, whether the patient is a newborn, an older child, or an adult, requires considering both the risks and the intended benefits of the transfusion

Contemporary trends in the surgical management of aortic valve disease

Introduction: Aortic valve pathology carries a high mortality burden. Its incidence is growing in proportion to the continuous ageing of the population. Surgery remains the gold standard in the treat- ment of severe aortic valve disease. Methods: We performed a retrospective analysis of the University Hospital Center Zagreb’s cardiac sur- gical database from 2009 to 2020, focusing on surgical aortic valve replacement (SAVR). We dichoto- mized patients with respect to the date of their surgical procedures into two eras. Group 1 included patients operated from 2009-2014, whereas Group 2 included patients operated on from 2015-2020. Results: A total of 1012 SAVRs were identified during the study period. The procedural volume over the two identical 6-year time periods increased in the latter era from 413 to 598. When comparing groups 1 and 2, we have observed in increase in the number of patients with diabetes (19% vs. 26%, P=0.015) and coronary artery disease (14% vs. 18%, P=0.099). The composite risk assessment score increased significantly from 3.0±2.4 to 3.2±2.7, P=0.023. Despite an increase in the comorbidity burden of the targeted patient population, the periprocedural mortality remained the same (2.1% vs 2.5%, P=0.835). The per-patient averaged volume of transfused packed red blood cells decreased from 839±954 to 614±821 ml, P<0.001. An increase in the proportion of tissue valve implantations in com- parison to mechanical prostheses was also noted in the present era (58% vs 68%, P=0.001) Conclusion: Despite an increasingly more complex patient population referred for SAVR in the con- temporary era, the results have remained excellent. The introduction of transcatheter methods should measure up to the surgical standard

Contemporary trends in the surgical management of aortic valve disease

Introduction: Aortic valve pathology carries a high mortality burden. Its incidence is growing in proportion to the continuous ageing of the population. Surgery remains the gold standard in the treat- ment of severe aortic valve disease. Methods: We performed a retrospective analysis of the University Hospital Center Zagreb’s cardiac sur- gical database from 2009 to 2020, focusing on surgical aortic valve replacement (SAVR). We dichoto- mized patients with respect to the date of their surgical procedures into two eras. Group 1 included patients operated from 2009-2014, whereas Group 2 included patients operated on from 2015-2020. Results: A total of 1012 SAVRs were identified during the study period. The procedural volume over the two identical 6-year time periods increased in the latter era from 413 to 598. When comparing groups 1 and 2, we have observed in increase in the number of patients with diabetes (19% vs. 26%, P=0.015) and coronary artery disease (14% vs. 18%, P=0.099). The composite risk assessment score increased significantly from 3.0±2.4 to 3.2±2.7, P=0.023. Despite an increase in the comorbidity burden of the targeted patient population, the periprocedural mortality remained the same (2.1% vs 2.5%, P=0.835). The per-patient averaged volume of transfused packed red blood cells decreased from 839±954 to 614±821 ml, P<0.001. An increase in the proportion of tissue valve implantations in com- parison to mechanical prostheses was also noted in the present era (58% vs 68%, P=0.001) Conclusion: Despite an increasingly more complex patient population referred for SAVR in the con- temporary era, the results have remained excellent. The introduction of transcatheter methods should measure up to the surgical standard