Comparison of FIT Tests
Spoon Feed
Commonly used fecal immunochemical tests (FIT) tests have significant differences in test performance.
Source
Comparative Performance of Common Fecal Immunochemical Tests : A Cross-Sectional Study. Ann Intern Med. 2024 Oct;177(10):1350-1360. doi: 10.7326/M24-0080. Epub 2024 Sep 3. PMID: 39222513
Six-Month MINT RCT Mortality – AMI Transfusion Strategies
Spoon Feed
In patients with acute MI, restrictive blood transfusion thresholds (hemoglobin 8g/dL) had similar rates of all-cause death and recurrent MI at 6 months. However, the 6-month hazard of cardiac death was 52% greater (9.0% vs 6.1%; HR 1.52, 95%CI, 1.19–1.94) in the restrictive transfusion group, largely due to increased cardiac death during the first 30 days.
Source
Restrictive or Liberal Transfusion Strategy in Patients With Acute Myocardial Infarction and Anemia: 6-Month Mortality in the MINT Trial. Circulation. 2024 Sep 24;150(13):1064-1066. doi: 10.1161/CIRCULATIONAHA.124.069917. Epub 2024 Sep 2. PMID: 39221566.
LR or NS for Sickle Cell Pain Crisis?
Spoon Feed
For sickle cell patients (particularly Hgb SS) with a vaso-occlusive episode (VOE), large volume resuscitation (>2L) with lactated ringers (LR) has been shown to have improved outcome measures compared to normal saline (NS).
Source
Lactated Ringer vs Normal Saline Solution During Sickle Cell Vaso-Occlusive Episodes. JAMA Intern Med. 2024 Sep 9:e244428. doi: 10.1001/jamainternmed.2024.4428. Epub ahead of print. PMID: 39250114; PMCID: PMC11385329.
Does Liberal Transfusion Benefit Patients with TBI?
Spoon Feed
In ICU patients with traumatic brain injury (TBI) and anemia, transfusing blood to a liberal hemoglobin threshold (10 g/dL) compared to a restrictive threshold (7 g/dL) did not lead to better neurological outcomes at 6 months.
Source
Liberal or Restrictive Transfusion Strategy in Patients with Traumatic Brain Injury. N Engl J Med. 2024 Jun 13. doi: 10.1056/NEJMoa2404360. Epub ahead of print. PMID 38869931.
Parts or the Whole Blood for Trauma Patients?
Spoon Feed
In trauma patients, 24-hour mortality rate increased with increasing ratio of packed red blood cells (pRBC) to whole blood (WB) transfusion, even when pRBC transfusion was balanced with platelets and fresh frozen plasma (FFP). Mortality rate was lowest in patients transfused with whole blood alone.
Should We Use Whole Blood for Trauma Patients?
Spoon Feed
Trauma patients who were resuscitated with whole blood compared to component therapy had improved 24-hour mortality and a decrease in the total amount of blood products needed for resuscitation.
Source
Doing more with less: low-titer group O whole blood resulted in less total transfusions and an independent association with survival in adults with severe traumatic hemorrhage. J Thromb Haemost. 2024 Jan;22(1):140-151. doi: 10.1016/j.jtha.2023.09.025. Epub 2023 Oct 4.
More Boxcars? Transfusion Trigger for STEMI and NSTEMI
Please read this announcement about upgrades to JournalFeed (CME, Amal Mattu, new website)! We also need to do a price increase due to rising costs. Price changes started Dec. 1, 2023 for new subscribers and on Jan 1, 2024 for current subscriber auto-renewals. If cost is a barrier for you, please read the announcement. We want to help! ~Clay Smith
Spoon Feed
Liberalizing the transfusion threshold to 10 g/dL (compared to 7-8 g/dL) for patients with myocardial infarction did not improve composite outcomes of myocardial infarction or death at 30 days.
Source
Restrictive or Liberal Transfusion Strategy in Myocardial Infarction and Anemia. N Engl J Med. 2023 Nov 11. doi: 10.1056/NEJMoa2307983. Epub ahead of print.
Hemolytic Uremic Syndrome from Shiga-Toxin Producing E. coli
Spoon Feed
This article provides a review of hemolytic-uremic syndrome (HUS) associated with Shiga toxin-producing Escherichia coli (STEC) infection. This condition, which disproportionately impacts children under five, is defined by thrombocytopenia, non-immune hemolytic anemia, and azotemia caused by thrombotic microangiopathy.
900% Greater Odds of Going Home – Nasal Fentanyl for Pediatric Sickle Cell Crisis
Spoon Feed
In this large, multi-center retrospective study of academic pediatric emergency departments across the US and Canada, researchers found that children presenting with sickle cell disease vaso-occlusive events had nine times (900%) greater adjusted odds of discharge home if given intranasal fentanyl (INF).
Source
Intranasal fentanyl and discharge from the emergency department among children with sickle cell disease and vaso-occlusive pain: A multicenter pediatric emergency medicine perspective. Am J Hematol. 2023 Apr;98(4):620-627. doi: 10.1002/ajh.26837. Epub 2023 Feb 6.
Transfusion Trigger – New AABB Guidelines for Adults and Children
Spoon Feed
For hemodynamically stable adults and children, 7g/dL is the best transfusion trigger, with a few exceptions.
Source
Red Blood Cell Transfusion: 2023 AABB International Guidelines. JAMA. 2023 Oct 12. doi: 10.1001/jama.2023.12914. Online ahead of print.