BackgroundTransfusion-associated hyperkalemic cardiac arrest is a serious complication in patients receiving packed red blood cell (PRBC) transfusions. Mortality from hyperkalemia increases with large volumes of PRBC transfusion, increased rate of transfusion, and the use of stored PRBCs. Theoretically, hyperkalemia may be complicated by low cardiac output, acidosis, hyperglycemia, hypocalcemia, and hypothermia. In this study, we focus on transfusion-related hyperkalemia involving only medical intensive care unit (MICU) patients.MethodThis prospective observational study focuses on PRBC transfusions among MICU patients greater than 18 years of age. Factors considered during each transfusion included patient’s diagnosis, indication for transfusion, medical co-morbidities, acid-base disorders, K+ levels before and after each PRBC transfusion, age of stored blood, volume and rate of transfusion, and other adverse events. We used Pearson correlation and multivariate analysis for each factor listed above and performed a logistic regression analysis.ResultsBetween June 2011 and December 2011, 125 patients received a total of 160 units of PRBCs. Median age was 63 years (22 - 92 years). Seventy-one (57%) were females. Sixty-three patients (50%) had metabolic acidosis, 75 (60%) had acute renal failure (ARF), and 12 (10%) had end-stage renal disease (ESRD). Indications for transfusion included septic shock (n = 65, 52%), acute blood loss (n = 25, 20%), non-ST elevation myocardial infarction (NSTEMI) (n = 25, 20%) and preparation for procedures (n = 14, 11%). Baseline K+ value was 3.9 ± 1.1 mEq/L compared to 4.3 ± 1.2 mEq/L post-transfusion respectively (P = 0.9). During this study period, 4% of patients developed hyperkalemia (K+ 5.5 mEq/L or above). The mean change of serum potassium in patients receiving transfusion ≥ 12 days old blood was 4.1 ± 0.4 mEq/L compared to 4.8 ± 0.3 mEq/L (mean ± SD) in patients receiving blood 12 days or less old. Sixty-two patients (77.5%) that were transfused stored blood (for more than 12 days) had increased serum K+; eight (17.7%) patients received blood that was stored for less than 12 days. In both univariate (P = 0.02) and multivariate (P = 0.04) analysis, findings showed that among all factors, transfusion of stored blood was the only factor that affected serum potassium levels (95% CI: 0.32 - 0.91). No difference was found between central and peripheral intravenous access (P = 0.12), acidosis (P = 0.12), ARF (P = 0.6), ESRD (P = 0.5), and multiple transfusions (P = 0.09). One subject developed a sustained cardiac arrest after developing severe hyperkalemia (K+ = 9.0) following transfusion of seven units of PRBCs. Multivariate logistic regression showed linear correlation between duration of stored blood and serum K+ (R2 = 0.889).ConclusionThis study assesses factors that affect K+ in patients admitted to MICU. Results from the study show that rise in serum K+ level is more pronounced in patients who receive stored blood (> 12 days). Future studies should focus on the use of altered s...

Introduction Thrombocytosis is a common disorder in patients diagnosed with iron deficiency anemia. The decreased platelet counts commonly found iron deficiency anemia is rarely reported in clinical practice. The exact mechanism of the occurrence of thrombocytopenia in iron deficiency anemia remains unclear. In this case report we discuss a triad of symptoms seen in the African American population: Iron deficiency anemia, menorrhagia and thrombocytopenia. Case presentation A 40 year old multiparous African-American woman presented with heavy vaginal bleed, severe anemia (3.5 g/dL) and thrombocytopenia (30,000/mm3). The peripheral blood smear showed marked microcytic hypochromic cells with decreased platelets counts. After excluding other causes of thrombocytopenia and anemia, increased red cell distribution width and low iron saturation confirmed the diagnosis of iron deficiency anemia. Treatment for iron deficiency anemia was initiated with intravenous and oral iron supplements. Two months following treatment of iron deficiency anemia, the triad of manifestations resolved and patient remained stable. Conclusion Profound degree of iron deficiency anemia can present with thrombocytopenia and severe menorrhagia. Iron replacement should be the main treatment goal in these patients. This case report further supports the 2 compartment model of the role of iron in maintaining platelet counts.

Crohn disease is an immune-mediated inflammatory condition with gastrointestinal and extraintestinal manifestations in patients. Pulmonary involvement of Crohn disease is one manifestation. There have been case reports which have shown Crohn disease and lung nodules which were noted to be histopathological as cryptogenic organizing pneumonia (COP). In our case, a 22-year-old woman with Crohn disease was seen with complaints of chest pain and cough. Computed tomographic scan of chest showed multiple bilateral lung nodules, for which biopsy was done, which showed COP. The case study is followed by a deeper discussion of COP and the extraintestinal manifestation seen in inflammatory bowel disease.

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Introduction: Serum ferritin has emerged as an independent marker predicting the outcome of critically ill patients. The cutoff value of ferritin in predicting mortality in septic children is not well established. Objective: The aim is to determine the cutoff value of ferritin which is, best predictive of mortality in patients with age from 1 month to 12 years with a diagnosis of septic shock or severe sepsis and to evaluate correlation with PRISM III score, and Pediatric Logistic Organ Dysfunction score (PELODS). Materials and Methods: A prospective observational study was conducted over a period of 2 years at pediatric intensive care unit (PICU) in children with age from 1 month to 12 years with septic shock or severe sepsis and PICU stay >24 h. Children with autoimmune diseases, primary hemophagocytic lymphohistiocytosis, blood transfusion in the past 4 months, known malignancies and immunosuppressive treatment were excluded. PRISM-III and PELODS were assessed to predict the risk of mortality and severity of disease. The highest value of ferritin was taken to draw area under the curve using receiver operating characteristic curve and determine cutoff value. Results: Out of 176 children of septic shock or severe sepsis, 132 were included in the study. Mortality rate was 22.7% (n = 30). PRISM III and PELODS-2 were significantly high in nonsurvivors (P ≤ 0.001 and 0.006, respectively). The cutoff value of ferritin at 2375 ng/dl had sensitivity 96.7% and specificity 88% to predict mortality. Ferritin level was positively correlated to the PRISM III and PELODS, correlation coefficient 0.447 and 0.601, respectively. Conclusion: Serum ferritin values ≥2375 ng/mL in children with septic shock, and severe sepsis was significantly associated with mortality. Its performance had a good correlation with PRISM III and PELODS.