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Background: Transfusion of blood products is a necessary part of successful delivery of myelosuppressive regimens in pediatric cancer. There is a paucity of literature characterizing outcomes or management of pediatric patients with cancer when transfusion is declined.
Aims: The objective of this paper is to describe the clinical characteristics, care, and outcomes of patients with cancer at risk for declining transfusion.
Methods And Results: A retrospective cohort of patients aged 0-21 years with cancer managed at Children's Healthcare of Atlanta between 2006 and 2020 and with ICD-9 codes indicating risk of "transfusion refusal" or Jehovah's witness (JW) religion was identified. Demographics, disease, and management were abstracted. Descriptive statistics were performed to examine associations with transfusion receipt. Among 35 eligible patients identified as at risk for declining transfusion, 89% had primary guardians who identified as JW, and 45.7% identified as Black, non-Hispanic. Only 40% of guardians actively declined transfusion. Transfusion recipients had significantly lower hemoglobin (g/dl) and platelet counts (1000/μl) at initial presentation (9.6 vs. 11.9, p < .002 and 116.0 vs. 406.5, p = .001, respectively) and at nadir (5.9 vs. 8.7, p < .001 and ≤ 10 vs. 154, p < .001, respectively) than non-recipients. Legal intervention was required in 36.4% of those who ultimately received a transfusion.
Conclusion: Among pediatric cancer patients whose medical record initially indicated a preference for no transfusion, 60% of guardians accepted blood products when prescribed for oncology care. Guidelines for systematic management and transfusion sparing approaches are needed to honor guardian's preferences when possible yet while maintaining equitable cancer outcomes in this population.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9875642 | PMC |
http://dx.doi.org/10.1002/cnr2.1665 | DOI Listing |
Transpl Immunol
December 2024
Tissue Typing Centre, Clinical Department for Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Croatia.
This retrospective study analyses the impact HLA heterozygosity, supertypes, and alleles have on incidence of graft versus host disease (GvHD), relapse, overall survival (OS), disease-free survival (DFS) and transplant-related mortality (TRM) after HSCT. The study included patients who underwent HSCT, typed at allele resolution level for HLA-A, B, C, -DRB1, -DQB1, and -DPB1 loci. The analysis performed on the entire patient cohort (N = 232) showed that HLA-B07 supertype positive patients demonstrated decreased incidence of relapse, better OS and DFS in comparison to those negative for HLA-B07 supertype.
View Article and Find Full Text PDFBone Marrow Transplant
December 2024
Department of Hematology, Toranomon Hospital, Tokyo, Japan.
Sci China Life Sci
December 2024
Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing, 100850, China.
Prolonged exposure to high-altitude environments may increase the risk of cognitive decline in young migrants. Recent studies suggest that hypobaric hypoxia-induced alterations in gut microbial composition could partly contribute to this risk. However, the absence of direct evidence from cohort studies and an unclear mechanism hinder intervention development based on this hypothesis.
View Article and Find Full Text PDFBMC Anesthesiol
December 2024
Department of Anesthesiology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana-cho, Chuo-ku, Chiba, 260-8670, Japan.
Background: Bleeding are common in cardiac surgery, with significant impacts on transfusion-related complications and patient prognosis. This study aimed to determine the differences in perioperative blood loss, transfusion rates, and the incidence of postoperative pulmonary complications (PPCs) with and without the use of positive end-expiratory pressure (PEEP) in patients undergoing off-pump coronary artery bypass graft surgery (OPCAB).
Methods: This single-center, retrospective study included 106 adult patients undergoing coronary artery bypass surgery without cardiopulmonary bypass from January 2018 to March 2022.
Retrovirology
December 2024
Iranian Tissue Bank and Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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