Morning MEDtalks with Dr KK Aggarwal

Morning Health Talk :

New Delhi, June 14, 2018 :

Mind Vision

Success will be yours unless you decide to QUIT after seeing size of the hurdles.

Kolkata hospital gives blood of wrong group to woman

Was the headline of the day? Abhijit Saha alleged that the hospital transfused AB positive blood instead of A positive on his wife Baishakhi Saha leading to multi organ failure. Twenty-five-year-old Baishakhi was admitted to Columbia Asia hospital on June 5 for a surgery for ectopic pregnancy.

The potential of an acute transfusion reaction (ATR) should be considered in any patient who develops adverse signs and symptoms during or within 24 hours after completion of a transfusion. Many of the most severe reactions occur within the first 15 minutes of transfusion.

Human error is the most likely cause of an ABO incompatibility reaction. If your transfusion uses the wrong blood type, it could be the result of mislabeled blood, incorrectly completed forms, or a failure to check donated blood before the transfusion.

1. Was it Acute hemolytic transfusion reaction? AHTR is a life-threatening reaction caused by acute intravascular hemolysis of transfused red blood cells (RBCs), often caused by a clerical error that results in transfusion of a product not intended for the recipient. Presenting symptoms include fever, chills, flank pain, and oozing from intravenous sites. Immediate communication with the transfusion service is critical to allow for appropriate record checking, which may prevent administration of a wrongly labeled unit to another patient. Treatment involves aggressive hydration and diuresis.
2. Was the patient IgA deficient? Any allergic reaction other than hives constitutes an anaphylactic transfusion reaction. This includes angioedema, wheezing, and/or hypotension. Anaphylactic reactions may occur in IgA-deficient individuals who produce anti-IgA antibodies that react with IgA in the transfused product, or patients who have allergies to another constituent in the transfused product. Management may include epinephrine, antihistamines, and vasopressors, depending on the degree of allergic symptoms
3. Was it a clerical error? If yes was it avoidable and was the SOPs followed?

Journal update: New England Journal of Medicine

Do not ignore concussions

Millions of Indians go to the hospital each year for treatment of mild traumatic brain injury (TBI), also known as concussion. Though rarely fatal, concussions can have long-term effects that decrease quality of life. These include headaches, trouble with memory and reasoning, difficulty sleeping, and depression. A recent study  published in JAMA Network Open on May 25, 2018 has found that almost a quarter of people with mild TBI still have related physical or mental problems a year later.

Z Drugs

Benzodiazepines and “Z” drugs (including zopiclone, zolpidem, and zaleplon) are widely prescribed as a long-term treatment for insomnia. However, the American Geriatrics Society Beers Criteria say they should be avoided, and their use in older adults has been associated with falls, dementia, motor vehicle accidents, and physical addiction. We must learn  deprescribing process. Most patients, when told that they can expect improvements in cognition and reduction of other adverse effects, are very willing to try to discontinue use of these drugs. And 60%-80% of patients can be successfully tapered off of these hypnotic drugs. Clinicians should discuss the need to slowly taper in all patients aged 65 years and older, regardless of treatment duration. Younger adults who have used these drugs for longer than 4 weeks should also slowly taper off. A goal reduction of 25% of the dose every 2 weeks is reasonable.

In stroke if we find carotid artery blockage in Doppler prefer Ticagrelor over aspirin

The Lancet Neurology Volume 16, No. 4, p301–310, April 2017

Ticagrelor is an effective antiplatelet therapy for patients with coronary atherosclerotic disease. I n a new SOCRATES trial, ticagrelor was superior to aspirin at preventing stroke, myocardial infarction, or death at 90 days in patients with acute ischaemic stroke or transient ischaemic attack when associated with ipsilateral atherosclerotic stenosis.

Nipah Virus Update

Encouragingly, the Coalition for Epidemic Preparedness Innovations, funded by the governments of Norway, Germany, and Japan, the Bill & Melinda Gates Foundation, and Wellcome Trust, announced on May 21 a US$25 million investment in two US biotechnology firms to accelerate work on a Nipah virus vaccine that has been in development at the Uniformed Services University of the Health Sciences for 15 years.

FICCI Healthcare Excellence Awards

The Awards now in its tenth year, has proven itself as one of the keenly awaited awards programs in the country, and is often quoted as the ‘Oscars’ of Indian Healthcare, due to its robust, acclaimed and constantly enhanced, objective assessment process. All of you can apply & download the E-brochure @ ficcihealthawards.com.

Dr KK Aggarwal
Padma Shri Awardee
Vice President CMAAO
President HCFI