Search Results (106)

Background/Objectives: Total hip arthroplasty (THA) routinely produces perioperative blood loss of 800–1200 mL, which raises concern that patients with thrombocytopenia may be at substantially higher surgical risk. Evidence on THA safety in this population, however, remains scarce. We compared perioperative and functional outcomes of THA between patients with preoperative platelet counts below 80 × 10⁹ cells/L and propensity score-matched controls with normal counts. Methods: In this retrospective matched cohort study, we reviewed 972 consecutive primary THAs. From this cohort, 30 patients with baseline platelet counts below 80 × 10⁹ cells/L were identified and matched 1:2 with 60 control patients who had normal platelet counts (≥150 × 10⁹ cells/L) using 1:2 nearest-neighbor matching. For all patients in the thrombocytopenic group, platelet counts were corrected to above 80 × 10⁹ cells/L prior to surgery; thus, the study evaluates outcomes after preoperative hematologic optimization rather than surgery performed at uncorrected thrombocytopenic levels. All patients were closely monitored for at least one week postoperatively to evaluate complications and clinical outcomes. Results: Operative time (78.2 vs. 78.8 min, p = 0.898), estimated blood loss (492 vs. 505 mL, p = 0.821), hematoma rate (6.7% vs. 1.7%, p = 0.257), surgical site infection (6.7% vs. 1.7%, p = 0.257), and Harris Hip Scores (86.1 vs. 85.7, p = 0.615) did not differ significantly between groups, although the absolute wound-complication rates were numerically about four-fold higher in the thrombocytopenic group and the small sample limited statistical power. The study group did require more packed red blood cell transfusions (7.43 vs. 1.4 units, p < 0.001) and had longer hospital stays (9.8 vs. 6.0 days, p = 0.017). Conclusions: When severe preoperative thrombocytopenia is corrected to above 80 × 10⁹ cells/L and managed with a structured perioperative protocol—meticulous intraoperative hemostasis and close postoperative surveillance for re-bleeding—THA can be performed with acceptable wound complication rates and functional outcomes and without catastrophic hemorrhage. Transfusion requirements and hospital stay remain higher, and the small sample size precludes concluding that the risk of infrequent complications is equivalent to that of patients with normal platelet counts. THA is therefore feasible, rather than unequivocally safe, under careful hematologic optimization. Full article

Background and Objectives: Obesity is a major global public health problem associated with numerous complications. Likewise, the use of antiplatelet and anticoagulant agents has increased with population aging and the growing burden of cardiovascular diseases. This study aimed to evaluate the effects of obesity and antiplatelet/anticoagulant therapy on the clinical presentation, bleeding severity, and short-term clinical outcomes of patients with gastrointestinal bleeding. Materials and Methods: A prospective cohort study was conducted in consecutive patients admitted with upper or lower gastrointestinal bleeding to a tertiary referral center between January 2024 and January 2025. Patients were categorized according to body mass index (BMI) and antithrombotic therapy status. Clinical characteristics, bleeding severity scores, treatment requirements, and short-term clinical outcomes were compared. Multivariable multinomial logistic regression analysis was performed to identify independent associations. Results: A total of 177 patients were included. Obese and overweight patients were significantly older than normal-weight patients (p = 0.001), whereas no significant differences were observed among BMI groups regarding the Glasgow–Blatchford score, pre-endoscopic Rockall score, transfusion requirements, endoscopic intervention, or short-term clinical outcomes. Patients receiving antiplatelet or anticoagulant therapy had significantly higher Charlson Comorbidity Index, bleeding severity scores, and packed red blood cell transfusion requirements than those receiving no antithrombotic therapy (all p < 0.01). However, after multivariable adjustment, these associations did not remain independent, and advanced age remained the only independent factor common to both treatment groups. Conclusions: Obesity was not independently associated with bleeding severity or short-term clinical outcomes in patients with gastrointestinal bleeding. Although antiplatelet and anticoagulant therapy were associated with more severe bleeding-related clinical findings, these associations were not independent after multivariable adjustment. Full article

Background/Objectives: Evidence on spinal versus general anesthesia in unilateral total knee arthroplasty (TKA) may not extend to one-week-staged bilateral surgery, where older patients receive two anesthetics in a short interval and intra-operative spinal-to-general conversion is common but rarely reported transparently. We compared peri-operative acute kidney injury (AKI) and transfusion between strategies in this setting. Methods: We retrospectively analyzed 207 patients (414 surgeries) undergoing one-week-staged bilateral primary TKA at one center. Co-primary endpoints were creatinine-based AKI (patient level) and packed-red-blood-cell transfusion (surgery level). Because 42 general-anesthesia-classified surgeries had an attempted spinal injection, the primary analysis used the initial anesthetic plan (an intention-to-treat analogue), reclassifying these as spinal, with as-treated classification as a sensitivity analysis; AKI was modeled at the patient level (any general anesthesia versus spinal–spinal) and transfusion per surgery. Results: Median age was 75 years and 82.6% were female; AKI affected 74 of 207 patients (35.7%) and transfusion 185 of 414 surgeries (44.7%). The adjusted any-general-anesthesia versus spinal–spinal estimate was not statistically significant and opposite the spinal-protective hypothesis (adjusted odds ratio 0.49, 95% confidence interval 0.23–1.01, p = 0.054), and no pre-specified sensitivity scenario survived Benjamini–Hochberg correction. Transfusion did not differ between strategies; among secondary endpoints, length of stay, hemoglobin drop, peak C-reactive protein, and intra-operative hypotension likewise showed no significant difference after multiplicity correction. Conclusions: These hypothesis-generating findings do not support changing anesthetic practice; the choice should remain individualized. Approximately 12% of attempted spinal anesthetics converted intra-operatively to general anesthesia—a record-based observation, not a validated failure rate. Full article

Background: Portal hypertension can lead to complications such as ascites, hepatic encephalopathy, esophageal varices, and gastrointestinal (GI) bleeding, all of which are associated with significant morbidity and mortality. Variceal bleeding is the most severe complication, with an estimated mortality of up to 30%. In children, evidence-based guidelines for the management of GI bleeding secondary to portal hypertension are lacking. In this con-text, octreotide, a synthetic somatostatin analog approved for other indications, has been increasingly used off-label and represents a paradigmatic example of drug re-purposing in pediatrics. Methods: Following the 2020 PRISMA guidelines, this systematic review evaluated the efficacy and safety of octreotide for the treatment of portal hyperten-sion-related GI bleeding in children. A comprehensive search of six sources, including five bibliographic databases (PubMed, Embase, Web of Science, Cochrane Library, and EBSCOhost) and the ClinicalTrials.gov registry, was conducted to identify studies in-cluding pediatric patients with GI bleeding secondary to portal hypertension. Results: Three non-randomized observational studies were included, assessing bleeding recurrence, packed red blood cell requirements, and adverse events following octreotide admin-istration. Overall, 33 patients were analyzed, with a mean age of 6.3 years. One study reported a reduction in rebleeding episodes and transfusion requirements after oc-treotide treatment. Across all included studies, no serious adverse events were ob-served; mild and reversible hyperglycemia was the only reported drug-related effect. Quantitative synthesis was not feasible due to substantial heterogeneity, missing data, and a serious risk of bias, resulting in very low certainty of evidence. Conclusions: Octreotide may represent a feasible therapeutic option for portal hypertension-related GI bleeding in children; however, further prospective and standardized studies are needed to establish its long-term safety and efficacy. Full article

Aim: Retinopathy of prematurity (ROP) is the leading cause of blindness in preterm infants. In this study, we evaluated the potential role of anemia and packed red blood cell (RBC) transfusions as risk factors in ROP development. Methods: A retrospective cohort study was conducted on premature infants who met the following inclusion criteria: infants with gestational age (GA) ≤ 32 weeks and very low birth weight (VLBW) who were admitted to the Neonatology-Preterm Department of Emergency Pediatric Hospital Cluj-Napoca during a two-year period (from 1 January 2023 to 31 December 2024). We investigated differences in the following perinatal characteristics between the two groups, those with ROP and those without: GA, birth weight (BW), severe respiratory distress syndrome, early-onset and late-onset sepsis, hemoglobin (Hb) levels, and RBC transfusions. We used the statistically significant variables to perform binary logistic regression. Results: A total of 124 newborns were recruited, with the following inclusion criteria: GA ≤ 32 weeks and BW ≤ 1500 g, of whom 79 received at least one RBC transfusion prior to 36 weeks corrected GA. Of them, 48 developed ROP with an incidence of 38.7%. In 20 cases, ROP required treatment. To adjust for clinical illness, a binary logistic regression model was created, including known risk factors for ROP and illness severity (GA, severe respiratory distress syndrome, and early- and late-onset sepsis) that were closely related to the risk of ROP development. For this regression model, Nagelkerke R-squared = 0.358, p < 0.001, and the AOR was 4.812 (95% CI: 1.374–16.847). Conclusions: RBC transfusions increased the risk of ROP. Full article

Introduction: Moderate-to-severe TBI (msTBI) disproportionately affects younger populations with high mortality and severe morbidity amongst survivors. A higher hemoglobin level has been suggested to improve oxygen delivery to the injured brain, and recent randomized trials revealed that more liberal hemoglobin (Hgb) transfusion thresholds may improve 6-month neurologic functional outcomes measured by Glasgow Outcome Scale Extended (GOS-E). This article aims to perform a comprehensive meta-analysis of functional neurologic outcomes and early mortality in msTBI patients with liberal (8 g/dL) versus restrictive (7 g/dL) hemoglobin (Hgb) transfusion thresholds. Methods: The Medline, Embase, and Cochrane databases were searched for primary literature concerned with msTBI and early Hgb transfusion thresholds, from inception to October 2025. Risk of bias was assessed for all selected articles. With a common-effect model, we estimated the pooled odds ratio of the primary outcome (6-month unfavorable outcome defined as GOS-E ≤ 4 or 5) and the secondary outcome (30-day mortality) for liberal versus restrictive Hgb transfusion thresholds. Results: After reviewing 484 articles, 12 met the inclusion criteria with 8 reporting 6-month functional neurological outcomes and 10 that reported 30-day mortality. After a direct comparison of 5208 cumulative patients, those with more liberal transfusion thresholds had a statistically significant reduction in unfavorable outcomes at 6 months (OR = 0.67; 95% CI [0.58–0.77]; p < 0.0001) compared to those with restrictive thresholds. Liberal transfusion thresholds showed no significant effect on 30-day mortality with the direct comparison of 4589 cumulative patients (OR = 0.93, 95% CI [0.78–1.11]). Conclusions: Higher Hgb transfusion thresholds in patients presenting with msTBI can improve functional outcomes at 6 months with a lack of significant effects on 30-day mortality. Full article

Background/Objectives: While packed red blood cell transfusions are commonly administered in anemic neonates, transfusion strategies in preterm infants have been the subject of debate for decades, particularly due to questionable long-term benefits and limited evidence regarding short-term physiological effects. In non-intubated preterm infants, established transfusion thresholds are considered, but individual clinical judgment often plays an important role in the final decision. This study aims to assess the short-term cardiorespiratory effects of red blood cell transfusions in non-intubated very-low-birth-weight (VLBW) infants who were either spontaneously breathing or receiving non-invasive respiratory support. Methods: Retrospective, single-center analysis of 68 VLBW infants (<1500 g) who received 99 red blood cell transfusions between 2019 and 2023. Cardiorespiratory parameters were observed over a 24 h period before and after transfusion. Results: Following transfusion, there was a significant decrease in the frequency of bradycardia events per 24 h (6.51 ± 5.55 to 4.24 ± 3.8; p = 0.004), accompanied by an improvement in the depth of oxygen desaturations (78.7 ± 4.18 to 81.0 ± 3.71; p = 0.001). No significant changes were detected in the desaturation frequency, FiO₂ or heart rate. Conclusions: In clinically stable very-low-birth-weight infants receiving non-invasive ventilatory support, packed red blood cell transfusion is associated with modest, short-term improvements in cardiorespiratory stability. However, these effects are limited in scope. Further research is needed to identify which patient subgroups derive the most significant benefit from these transfusions. Full article

Background: Blood transfusion is a life-saving intervention but is associated with adverse reactions in a subset of recipients. An acute transfusion reaction (ATR) is defined as any unfavorable response occurring within 24 h of blood component administration. This retrospective observational study aimed to determine the frequency and characteristics of ATRs at King Saud Medical City (KSMC), Riyadh, Saudi Arabia. Methods: We conducted a retrospective study using data from the Transfusion Medicine Laboratory (TML) at KSMC between January 2019 and December 2023. Demographic, clinical, and laboratory data from 238 confirmed ATR records were analyzed using SPSS v21.0. Chi-square, Mann–Whitney U, and risk ratio analyses were performed; p < 0.05 was considered statistically significant. Results: Among 238 patients (59.2% female; mean age 33.7 ± 18.5 years), allergic reactions were the most frequent ATR (70.2%, n = 167), followed by febrile non-hemolytic transfusion reactions (FNHTRs); (24.4%, n = 58). Packed red blood cell (PRBC) transfusion was the most commonly implicated product (82.4%; n = 196; p < 0.001). Fever, rash, itching, and chills were significantly associated with specific reaction subtypes (p < 0.001). The pattern of post-transfusion workup differed significantly across reaction types (p < 0.001). Age, gender, ward distribution, and reaction timing were not significant predictors of ATR occurrence. Conclusions: Allergic reactions are the predominant ATR form at KSMC. Demographic variables are not reliable predictors of ATR. Strengthening hemovigilance systems and clinician education is recommended to improve transfusion safety. Full article

Background and Objectives: This study aimed to evaluate the impact of body mass index (BMI) on post- operative outcomes in patients undergoing aortic arch repair with the frozen elephant trunk technique (FET). Materials and Methods: A total of 387 patients who underwent an FET procedure between 04/2014 and 11/2024 were retrospectively analyzed. Patients were divided into four groups according to BMI: underweight (BMI < 18.5, n = 12) normal weight (BMI: 18.5 to <25, n = 150), overweight (BMI: 25 to <30, n = 154), and obese (BMI: ≥30, n = 71). Patient characteristics and clinical outcomes were compared across groups. Multivariable Cox regression, interaction analysis, and restricted cubic spline modelling were performed using R (Version 4.4.3). Results: Interaction analysis revealed BMI-dependent effect modification for several predictors. Insulin-dependent diabetes mellitus was associated with increased mortality only in patients with BMI < 25 kg/m² (interaction p = 0.003). Transfusion of packed red blood cells (PRBCs) also showed a significant interaction with BMI (p = 0.016), with a stronger effect in patients with BMI < 25 kg/m², although significant in both strata. Moreover, cross-clamp time demonstrated a BMI-dependent interaction (p = 0.047), with numerically higher mortality hazards in overweight patients (BMI > 25 kg/m²), but without statistically significant subgroup effects. Spline analysis indicated a non-linear, threshold-based association between overall mortality and BMI but does not reach statistical significance. Kaplan–Meier analysis showed no significant difference in 5-year survival among BMI categories. Conclusions: BMI should not be used as a primary risk stratification tool for survival after an FET procedure. Rather, attention should be paid to comorbid conditions and intraoperative factors that interact with BMI. For patients with lower BMI (<25 kg/m²), optimizing glycemic control and minimizing transfusion may improve outcomes. Data suggests that a reduction in cross-clamp time may be particularly beneficial in patients with higher BMI (>25 kg/m²). Future studies should aim to clarify the impact of BMI on outcomes after FET, particularly in the context of patient selection and perioperative optimization strategies. Full article

Background: Postpartum anemia frequently requires packed red blood cell (PRBC) transfusion; however, the contribution of intravenous iron to early hematologic recovery remains uncertain. This study evaluated hemoglobin dynamics following transfusion and the effect of adjunctive intravenous iron therapy. Methods: In this retrospective cohort study, 61 obstetric patients requiring PRBC transfusion were included. Hematologic parameters were assessed at admission, postoperatively, post-transfusion, and at day 7. Patients were stratified according to the administration of intravenous ferric carboxymaltose. Hemoglobin changes and reticulocyte response were analyzed, including a subgroup receiving two PRBC units. Results: Mean hemoglobin decreased from 9.36 ± 1.16 g/dL at admission to 6.33 ± 1.05 g/dL postoperatively, increased to 8.32 ± 0.78 g/dL after transfusion, and reached 8.75 ± 0.97 g/dL at day 7 (p < 0.001). No significant differences between groups were observed before or immediately after transfusion. At day 7, hemoglobin was significantly higher in patients receiving intravenous iron compared with those without supplementation (9.63 ± 1.03 vs. 8.03 ± 0.36 g/dL, p < 0.001). The increase in hemoglobin from post-transfusion to day 7 was greater in the iron group (1.14 ± 0.84 vs. −0.15 ± 0.33 g/dL, p < 0.001), accompanied by a higher reticulocyte response (2.56 ± 0.49% vs. 0.93 ± 0.26%, p < 0.001). Similar findings were observed in the two-unit subgroup. Conclusions: Adjunctive intravenous iron was associated with improved early hemoglobin recovery after transfusion without affecting immediate correction, supporting its clinical use in obstetric patients. Full article

Background: The clinical significance of Helicobacter pylori (H. pylori) infection in acute non-variceal upper gastrointestinal bleeding (NVUGIB) remains uncertain, particularly regarding short-term outcomes beyond rebleeding. Methods: We conducted a single-center retrospective cohort study of consecutive adults admitted with acute NVUGIB to Hatyai Hospital, Thailand, between January 2016 and December 2020. H. pylori status was determined during the index hospitalization using rapid urease testing and/or histopathologic examination of gastric biopsy specimens obtained during upper gastrointestinal endoscopy. The primary outcome was 30-day all-cause mortality. Secondary outcomes included in-hospital mortality, rebleeding, requirement of packed red blood cell transfusion, and length of hospital stay. Multivariable regression analyses were performed to adjust for potential confounders. Results: Among 933 patients, 289 (31.0%) were H. pylori-positive and 644 (69.0%) were H. pylori-negative. The H. pylori-positive group was younger, predominantly male, and had lower rates of cirrhosis and prior proton pump inhibitor use. They also more often had peptic ulcer bleeding and underwent earlier endoscopy. H. pylori positivity was independently associated with lower 30-day mortality (adjusted odds ratio 0.39, 95% confidence interval 0.18–0.84), but not with rebleeding, requirement of transfusion, or length of stay. Conclusions: H. pylori positivity was associated with lower short-term mortality in acute NVUGIB, although this finding may reflect baseline clinical differences rather than a direct effect on bleeding severity. Full article

Background/Objectives: We aim to identify the postoperative acute kidney injury (AKI) risk factors and the predictors of severe AKI derived from routine perioperative elements in patients with aortoiliac occlusive disease who underwent aorto-bifemoral bypass as arterial revascularization. This involves a dynamic assessment throughout the perioperative period. Methods: Preoperative, intraoperative, early postoperative and day-one-after-surgery data were retrospectively reviewed in consecutive patients who underwent elective aorto-bifemoral bypass for aortoiliac occlusive disease classified as TASC II D at the “Prof. C.C. Iliescu” Emergency Institute for Cardiovascular Diseases in Bucharest, Romania, between 2017 and 2023. Results: Preoperative clearance of creatinine (OR 1.037, CI95%: 1.009–1.066), the duration of the surgery (OR 1.435, CI 95%: 1.100–1.873), and the change between the day-one-after-surgery and preoperative systemic inflammatory response index (DeltaSIRI_1_preop) (OR 1.080, CI 95%: 1.012–1.152) were identified as independent risk factors for postoperative AKI in patients undergoing aorto-bifemoral revascularization for aortoiliac occlusive disease. The most severe form of AKI was strongly predicted by the number of packed red blood cells transfused (AUC 0.924, p = 0.001), the patient’s age (AUC 0.895, p = 0.001), and the duration of the surgery (AUC 0.895, p = 0.001). Furthermore, various routine and cost-effective variables related to the preoperative period, the early postoperative period, and the first day after surgery also demonstrated significant predictive value. Conclusions: We conducted a dynamic perioperative assessment of AKI associated with major vascular surgery. This aims to equip clinicians with a practical and cost-effective tool for evaluating AKI, thereby facilitating a more individualized approach to the diagnosis of this complication. Full article

Background and Objectives: Outcomes after trauma are traditionally attributed to injury severity and acute physiologic derangement. However, host vulnerability at presentation—reflecting underlying physiologic and nutritional status—may also be associated with bleeding severity and transfusion requirements following acute injury. Whether such vulnerability contributes additional risk information beyond established factors remains incompletely understood. Materials and Methods: We conducted a retrospective cohort study of adult trauma patients using a single-center trauma registry. Host vulnerability was assessed using a composite score (CE; range 0–3) based on admission hypoalbuminemia (<3.5 g/dL), anemia (hemoglobin < 11 g/dL), and reduced renal function (estimated glomerular filtration rate < 60 mL/min/1.73 m²). Primary outcomes were any blood transfusion and massive transfusion, defined as transfusion of ≥10 units of packed red blood cells within 24 h of admission. Associations between CE score and transfusion outcomes were evaluated using univariable and multivariable logistic regression models adjusted for age, Injury Severity Score (ISS), admission lactate level, and systolic blood pressure (SBP). Results: Among 4105 trauma patients, transfusion requirements increased progressively with higher CE scores. Rates of any transfusion rose from 21.7% in patients with CE 0 to 78.6% in those with CE 3, while massive transfusion increased from 1.9% to 23.1% across the same categories. In multivariable analyses, each 1-point increase in CE score was independently associated with higher odds of any transfusion (adjusted odds ratio [aOR] 3.21, 95% confidence interval [CI] 2.80–3.68) and massive transfusion (aOR 1.73, 95% CI 1.45–2.07). Conclusions: A composite score reflecting host vulnerability at presentation was associated with bleeding severity and transfusion requirements after trauma, beyond injury severity and acute physiologic factors. These findings suggest that simple laboratory-based markers may provide additional information for early risk stratification of hemorrhagic outcomes after trauma. Full article

Background/Objectives: Wolfram syndrome type 1 (WS1) is a rare, progressive, multisystem neurodegenerative disorder characterized by diabetes mellitus, optic atrophy, diabetes insipidus, and sensorineural hearing loss. As survival has improved, an increasing number of affected women are reaching reproductive age. However, evidence on pregnancy and peripartum management in WS1 remains scarce, and practical guidance is limited. This case report describes the multidisciplinary management of pregnancy and delivery in a woman with genetically confirmed WS1 and highlights key considerations for peripartum care. Case Presentation: A woman with genetically confirmed WS1 and long-standing multisystem involvement, including diabetes mellitus, diabetes insipidus, neurogenic bladder requiring frequent self-catheterization, progressive neurologic manifestations, and severe sensory impairment, achieved pregnancy through assisted reproduction with oocyte donation and was closely monitored by a multidisciplinary team. Due to persistent breech presentation, a planned external cephalic version was performed at 37 + 5 weeks’ gestation with immediate availability for cesarean delivery. After unsuccessful attempts, cesarean delivery was performed under combined spinal–epidural anesthesia. Peripartum management focused on strict glycemic control, careful monitoring of fluid balance and urine output, neuraxial anesthesia with proactive hemodynamic management, precautions related to the cochlear implant, and tailored communication strategies. Postpartum recovery was favorable, although anemia on postoperative day 1 required transfusion of one unit of packed red blood cells and intravenous iron therapy. Discussion and Conclusions: Pregnancy in WS1 represents a high-risk clinical scenario because of the coexistence of endocrine, urologic, and neurologic comorbidities, while published evidence on peripartum management remains limited. This case supports an individualized, multidisciplinary approach to obstetric and anesthetic planning and the use of a practical framework to optimize peripartum management and enhance maternal–fetal safety in this rare condition. Full article

Background/Objectives: An 8-kg, 16-month-old child was brought to the emergency department of a regional community hospital with shallow respirations. Due to her pallor and the diluted appearance of the first blood sample, the emergency physician suspected sepsis associated with severe anemia. Her first laboratory results revealed a hemoglobin of 1.7 g/dL. Subsequent laboratory data revealed positive fibrin split products and hypofibrinogenemia with reticulocytosis. Because this regional community hospital did not have a pediatric intensivist, the emergency physician instead consulted a neonatal intensivist for guidance. Methods: A femoral intraosseous line was placed to allow aggressive massive transfusion. After consultation with the neonatal intensivist, packed red blood cells were transfused at a rate of 30 mL/kg/h. After transfusion, the patient became agitated and required repeated paralytic, sedative, and analgesic boluses of succinylcholine, ketamine, midazolam, dexmedetomidine, and fentanyl, with fentanyl and dexmedetomidine drips. The patient arrived at a tertiary care center 13 h after admission. Results: At the tertiary care center, the patient was weaned off the drips and was theorized to have secondary autoimmune hemolytic anemia due to sepsis after positive direct and indirect Coombs test. She was treated with a course of antibiotics, including cefepime and vancomycin, without steroids or immunotherapy. Five months later, her hemoglobin had returned to 12.1 g/dL, and she tested negative on direct and indirect Coombs test. Conclusions: This case highlights the importance of collaboration between and within departments to successfully manage pediatric hemostatic resuscitation. Full article