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Objective: Coronavirus disease(COVID-19) rapidly spread worldwide after its first report in December 2019, in China. This spread drastically reduced the number of blood donations, thereby creating a shortage at blood banks in the whole world. Turkish Red Crescent (TRC) is the only legal authority that organizes collection, production, storage and distribution of blood and blood products in Turkey. Only in case of emergency TRC gives permanent permission to hospitals; for collecting blood and producing its components through their own transfusion centers. This report describes how the COVID-19 impacted blood supplies of TRC and hospital demands in Turkey with an aim to improve the management of blood supply and demand during the COVID-19 and future pandemics. Method: A cross-sectional study was conducted within a period of nine months from November 1, 2019 to July 31, 2020. Data were retrospectively obtained from donor attendance and blood inventory records of TRC and included; 1) the number of donated units of apheresis platelet concentrates (APC) and blood to TRC, 2) the number of units of APC and erythrocyte suspensions (ES) supplied by the hospitals themselves, 3) the number of units of APC and ES supplied to hospitals by TRC (APCH and ESH). The periods before (first period) and after (third period) emergence of COVID-19 outbreak in Turkey were compared. Results: An increase of 52% in the number of APC donations, but a decrease of 22% in the number of blood donations (NBDs) were detected in the third period compared to the first one. Mean APCH values were 7081±550 and 5121±55 units in the first and third periods,respectively. The mean ESH values in the first, and third periods were 873±326, and 3694±3143 units. Conclusion: It is obvious that we have learnt many lessons from the COVID-19 pandemic, like how to face challenges in maintaining the balance between blood demand and blood supply. Utilizing media to encourage donors and implementation of Patient Blood Management on national and institutional levels may be some of the key components of a comprehensive strategy. The collaboration of Ministry of Health, TRC and hospitals was successful in securing a balance between blood supply and demand in Turkey, on which COVID-19 pandemic impacted significantly. [ABSTRACT FROM AUTHOR]

perfusion, are usually measured by blood gas analyzers simultaneously with blood gases. Although arterial blood is the “gold standard” for measurement of lactate, the interchangeable use of arterial and venous lactate measurements can avoid increased costs and iatrogenic anemia resulting from frequent blood sampling when evaluation of venous blood gas samples are preferred. In this study; we aimed to examine the correlation and agreement between the arterial lactate (AL) and central venous lactate (CVL) values in patients undergoing on-pump cardiac surgery. Method: Adult patients who had both arterial and central venous blood gas sampling simultaneously in three stages (T1: after anesthesia induction, T2: during cross- clamping, T3: during skin closure) of operation as part of anesthetic management were eligible for inclusion in this retrospective study. CVL and AL concentrations were estimated during blood gas analysis at stages T1, T2 and T3. Spearman Rho and Bland-Altman Tests were used to assess correlation and agreement between AL and CVL measurements, respectively. Results: Totally 366 pairs of blood samples were obtained from 122 eligible patients. The 95% limits of agreement were -0.07 to -0.00 at T1; 0.30 to -0.10 at T2 and -0.16 to -0.03 at T3. The 95% Cls were detected 0.86 to 0.93 (r=0.90 and p<0.0001) at T1;0.95 to 0.97 at T2 (r=0.96 and p<0.0001) and 0.92 to 0.96 (r=0.94 and p<0.0001) at T3. Conclusion: Although sampling from arterial lactate can be considered as the “gold standard” for lactate measurement, sampling from central venous blood is an acceptable alternative for lactate measurement in on-pump cardiac surgery patients. [ABSTRACT FROM AUTHOR]

Fahr Syndrome, which is a rare neurologic syndrome, is characterized by sporadic or genetically inherited basal ganglion calcification. There are some hypotheses about the pathophysiology of Fahr Syndrome related to a defect in calcium metabolism, metastatic calcium deposits and increased free radical production. Although patients are usually diagnosed with extrapyramidal symptoms, they may also present with cerebellar dysfunction, speech disorders, dementia and neuropsychiatric symptoms. We aimed to discuss sedation failure with dexmedetomidine and midazolam in a 49-year-old female patient with Fahr Syndrome who was admitted to our intensive care unit after suicidal carbamazepine overdose in this case report. Adequate sedation levels could not be reached although infusion of 1.5 μg kg-1 h-1 dexmedetomidine and bolus injections of 1.5 mg midazolam were administered. This may be due to the tolerance to sedatives developed by long-term use of antidepressant and antiepileptic agents. On the other hand; the unique sedative agent dexmedetomidine is a specific and selective α2 agonist and the widespread intracerebral calcification in our patient may have impaired α2 receptor activity. Besides, calcium metabolism disorder, one of the probable causes of Fahr Syndrome, may affect calcium-mediated inhibition of neurotransmitter release through α2 adrenoreceptors and reduced the effectiveness of dexmedetomidine. [ABSTRACT FROM AUTHOR]

Awareness about complications of transfusions of blood and blood products, their effects on mortality and morbidity and cost burden has increased in recent years which created the need for a new approach to transfusion practice. This new approach, defined as "Patient Blood Management (PBM)" aims to transfuse the right blood product to the right patient at the right time. Alteration of transfusion habits according to this new approach is quite difficult as seen in changing many established, traditional medical practices. Although there have been an increasing number of publications about the aim, context and results of PBM, there is limited studies and experience about the efficient implementation of this practice. In this article, the reports and clinical experiences of countries like USA and Australia that widely and successfully use this PBM project are reviewed. [ABSTRACT FROM AUTHOR]