No difference in myocardial iron concentration and serum ferritin with deferasirox and deferiprone in pediatric patients with hemoglobinopathies: A systematic review and meta-analysis
Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine. 2022
OBJECTIVES Iron overload is a common complication experienced by transfusion-dependent children with hemoglobin disorders. Chelators such as deferasirox (DFX) and deferiprone (DFP) are effective in overcoming this problem. We conducted this systematic review and meta-analysis to evaluate the effectiveness of DFX compared to DFP in treating iron overload amongst pediatric patients with hemoglobin disorders. MATERIAL AND METHODS PubMed and Cochrane Central were searched from their inception until Dec 21 2021, for randomized clinical trials (RCTs) and observational studies, which assessed the efficacy of DFX compared to DFP in the treatment of inherited hemoglobin disorders. The outcomes of interest included myocardial iron concentration (MRI T2*) at the end of the trial and change in mean serum ferritin (SF) levels at the 6 and 12 months mark. Weighted mean differences (WMDs) with their corresponding 95% confidence intervals (CIs) were calculated for continuous outcomes using random effects model. RESULTS A total of 5 studies comprising 607 children were included. The results of our analysis revealed no significant difference between DFX and DFP in MRI T2* at the end of treatment (WMD: -0.92;95% CI[-3.35,1.52]; p=0.46; I(2)=0). Moreover, there has been no significant difference noted in SF levels at both 6 months (WMD: 97.31; 95% CI[-236.16,430.77]; p=0.57; I(2)=0) and 12 months (WMD: 46.99; 95% CI[-191.42,285.40]; p=0.70; I(2)=0) respectively. CONCLUSION Our analysis shows no significant difference between the efficacy of DFX and DFP in the management of iron overload in children with inherited blood disorders. Future large-scale clinical trials are required to further validate our results.
Risk factors for blood transfusion in Cesarean section: A systematic review and meta-analysis
Transfusion clinique et biologique : journal de la Societe francaise de transfusion sanguine. 2021
OBJECTIVE The current study has been conducted to identify risk factors associated with blood transfusion in women undergoing cesarean section (C-section). A detailed account of risk factors associated with the blood transfusion will ultimately prevent unnecessary crossmatching in the hospital setups, leading to the conservation of declining blood supplies and resources without subjugating the quality of care. MATERIAL AND METHODS We performed a rigorous literature search using electronic databases, including PubMed, Cochrane CENTRAL, and Embase, for studies evaluating the risk factors for blood transfusion in the C-section published until March 31, 2021. The Newcastle-Ottawa Quality Assessment Scale was deployed to assess the methodologic quality of the included studies. Mean differences (MD) and odds ratios (OR) with 95% confidence intervals were calculated using Review Manager version 5.3. RESULTS The search yielded 1,563 records, 22 of which were eligible for inclusion, representing 426,094 women (10,959 in the transfused group and 415,135 in the non-transfused group). Participants in the transfused group had lower mean preoperative hematocrit (MD= -3.71 [-4.46, -2.96]; p< 0.00001; I(2)= 88%). Placenta previa (OR= 9.54 [7.23, 12.59]; p< 0.00001; I(2)= 88%), placental abruption (OR= 6.77 [5.25, 8.73]; p< 0.00001; I(2)= 72%), emergency C-section (OR= 1.92 [1.42, 2.60]; p< 0.0001; I(2)= 75%), general anesthesia (OR= 8.43 [7.90, 9.00]; p<0.00001; I(2)= 72%), multiple gestations (OR= 1.60 [1.24, 2.06]; p= 0.0003; I(2)= 85%), preterm labor (OR= 3.34 [2.75, 4.06]; p< 0.00001; I(2)= 85%), prolonged labor (OR= 1.68 [1.44, 1.96]; p< 0.00001; I(2)= 78%), unbooked cases (OR= 2.42 [1.22, 4.80]; p= 0.01; I(2)= 80%), hypertensive disorders of pregnancy (OR= 1.81 [1.72, 1.90]; p< 0.00001; I(2)= 71%), and fibroids (OR= 2.32 [1.55, 3.47]; p< 0.0001; I(2)= 72%) were significantly higher in the transfused group compared to the non-transfused group. Chronic hypertension (OR= 0.67 [0.29, 1.55]; p= 0.36; I(2)= 90%),maternal age (MD= 0.09 [-0.27, 0.45]; p= 0.62; I(2)= 50%), maternal body mass index (MD= -0.14 [-0.81, 0.53]; p= 0.67, I(2)= 86%), diabetes (OR= 0.93 [0.75, 1.15]; p= 0.51; I(2)= 52%), and malpresentation (OR= 0.65 [0.38, 1.11]; p= 0.13; I(2)= 64%) were not significantly associated with an increased risk of blood transfusion in C-section in the two groups. CONCLUSION Placenta previa, placental abruption, emergency C-section, booking status, multiple gestations, and preoperative hematocrit were the risk factors most significantly associated with blood transfusion, while a prior C-section did not increase the risk of transfusion.
Resuscitative Endovascular Balloon Occlusion of Aorta Versus Aortic Cross-Clamping by Thoracotomy for Noncompressible Torso Hemorrhage: A Meta-Analysis
The Journal of surgical research. 2021;270:252-260
BACKGROUND The effect of resuscitative endovascular balloon occlusion of aorta (REBOA) in lowering mortality rate compared to resuscitative thoracotomy (RT) is inconclusive. In this updated systematic review and meta-analysis, we determined the effectiveness of the two techniques in patients with noncompressible torso hemorrhage (NCTH). MATERIALS AND METHODS Online databases (PubMed, Embase, and MEDLINE) were searched until April 23, 2021, for original articles investigating the effect of REBOA on relevant outcomes (e.g., mortality in ED, mortality before discharge, in-hospital mortality, length of hospital stay and length of ICU stay) among NCTH patients in contrast to open aortic occlusion by RT. Data on baseline characteristics and endpoints were extracted. Review Manager version 5.4.1 and OpenMetaAnalyst were used for analyses. Risk ratios (RR) and the weighted mean differences (WMD) with corresponding 95% confidence intervals were calculated. RESULTS Eight studies were included having 3241 patients in total (REBOA 1179 and RT: 2062). The pooled analysis demonstrated that compared to RT, mortality was significantly lower in the REBOA group in all settings: In emergency department (ED) (RR 0.63 [0.45, 0.87], P = 0.006, I(2) = 81%), before discharge (RR= 0.86 [0.75, 0.98], P = 0.03, I(2 =) 93%), and in-hospital mortality (RR 0.80 [0.68, 0.95], P = 0.009, I(2 =) 85%). Similarly, the length of ICU stay was significantly lower in REBOA group (WMD = 0.50 [-0.48, 1.48], P = 0.32, I(2 =)97%). However, no significant differences were observed in the length of hospital stay (WMD = 0.0 [-0.26, 0.26] P = 1). CONCLUSIONS Our pooled analysis shows REBOA to be effective in reducing mortality among NCTH patients. However, due to limited studies, the positive findings should be viewed discreetly and call for further investigation.
Effect of Umbilical Cord Blood Sampling versus Admission Blood Sampling on Requirement of Blood Transfusion in Extremely Preterm Infants: A Randomized Controlled Trial
The Journal of pediatrics. 2019
OBJECTIVE To evaluate the effect of blood sampling from the placental end of the umbilical cord compared with initial blood sampling from neonates, on the need for first packed red blood cell transfusion in extremely preterm infants. We hypothesized that cord blood sampling could delay the time to first blood transfusion. STUDY DESIGN In this single-center, assessor blind, randomized controlled trial, we included extremely low birth weight neonates <28 weeks of gestational age at birth. Five milliliter of blood for initial laboratory investigations was collected either from the placental end of the umbilical cord (study group) or from the neonate upon neonatal intensive care unit admission (control group). Both groups received similar anemia prevention strategies. The primary outcome was the time (in days) to the first packed red blood cell transfusion, and was compared using survival analysis. RESULTS Eighty neonates were enrolled. The time to first transfusion was significantly delayed in the cord sampling group (30 vs 14 days, hazard ratio: 0.44, [95% CI 0.27-0.72], P < .001). Fewer neonates in the cord sampling group were transfused in the first 28 days of life (30% vs 75%, P < .001). Overall transfusion requirements and other clinical outcomes were similar in the groups. CONCLUSIONS Initial blood sampling from placental end of umbilical cord, when combined with anemia prevention strategies, significantly prolonged the time to first transfusion and reduced the need for early transfusions among extremely premature neonates. TRIAL REGISTRATION Ctri.nic.in/ (CTRI/2017/04/008320).