Browsing by Author "Kovač, Mirjana (7102654168)"

Introduction/Objective There is very limited data regarding the need for transfusion and its effect on the overall mortality of patients with coronavirus disease 2019 (COVID-19). The aim of our study is to determine the need for blood component transfusion in patents treated for COVID-19 infection. Methods This retrospective observational study included 4426 COVID-19-positive patients treated at the Bežanijska Kosa University Hospital Medical Center between June 23, 2020 and May 2, 2021. Of these patients, 826 were treated in the intensive care units of the hospital. Of the total number of patients, 326 (7.4%) received transfusions. The clinical presentation, the structure of the applied transfusion therapy, the laboratory parameters, and the treatment outcome were analyzed in this study. Results Of the 828 patients treated in the intensive care units, 151 (18.2%) patients required transfusion, while transfusion was necessary in a total of 4.9% of patients treated in the hospital wards. Of the total number of all transfused patients, 86% received erythrocytes, one-third of them received fresh frozen plasma, 10% received cryoprecipitate, while platelets were administered in around 6% of the patients. The mortality rate in the tested group was 46%. Conclusion The frequency of the application of blood components was significantly higher in patients with a severe form of the disease. The presence of comorbidities did not affect the need for transfusion therapy. In the group of patients treated in the intensive care units, 85% received erythrocytes, 39% received fresh frozen plasma, 19% received cryoprecipitate and 7% received platelets. © 2023, Serbia Medical Society. All rights reserved.

Introduction. Ischemic stroke (IS) is a heterogeneous disorder caused by several genetic and environmental risk factors. It was suggested that coagulation disorders cause 1-4% of cases with IS, especially in patients with early onset of IS. Case report. We describe a case of a young adult male who developed an unprovoked IS. Biochemical, immunological, and thrombophilia screening, as well as DNA sequencing, were performed in order to reveal molecular pathology underlying the stroke of the patient. Thrombophilia testing showed that patient was a homozygous carrier for PAI-1 4G/5G and MTHFR C677T mutations. Additional genetic analysis revealed the presence of the recently reported F2 c.1824C>T gene variant, located in the last exon of the prothrombin gene and has previously been shown to cause hyperprothrombinemia, hypofibrinolysis, and altered fibrin clot phenotype. Conclusion. Our results suggest that the newly reported F2 c.1824C>T gene variant might have a synergistic effect with PAI 4G/4G and MTHFR 677TT genotype in the formation of altered fibrin clot phenotype characterized by thin, densely packed fibrin fibers, which makes clot less susceptible to fibrinolysis and greatly increases the risk for early ischemic stroke onset. © The Author(s) 2022.

Background/Aim. Direct oral anticoagulants (DOACs) administration significantly interferes with coagulation as-says. The aim of the study was to evaluate the effect of DOACs and DOAC-Remove® on coagulation assays dur-ing thrombophilia testing. Methods. The study was car-ried out from January 2019 to the end of June 2020. It in-cluded 30 DOAC-treated patients, 14 females and 16 males aged 23 to 63 (median age 47.6 years), tested for thrombophilia due to venous thromboembolism (VTE). Thrombophilia testing was performed using DOAC-Remove® tablets (activated charcoal). The results before and after DOAC-Remove® were compared. Results. Posi-tive lupus anticoagulant (LA) results were observed in 20% apixaban, 100% dabigatran, and 70% rivaroxaban-treated patients, while in samples after DOAC-Remove®, the LA positivity was observed only in one from the apix-aban group. Before DOAC-Remove®, the activated pro-tein C (APC) resistance (APC-R) was measurable in 40% dabigatran and 80% rivaroxaban-treated patients, while, after using DOAC-Remove®, the APC-R was measurable in all cases. Comparing the results obtained from the sam-ples before and after DOAC-Remove®, a difference was noted in relation to all dilute Russell's viper venom time (dRVVT) coagulation tests, except for the dRVVT ratio in the apixaban group. Clot-based methods for detecting the APC resistance were significantly affected by dabigatran and less by rivaroxaban. Conclusion. DOACs were prac-tically inactivated after the addition of the DOAC-Remove®, which made it possible to perform analyses for the LA and APC-R testing freely and obtain relevant re-sults. © 2022 Inst. Sci. inf., Univ. Defence in Belgrade. All rights reserved.

Introduction The important indicators of the quality of work in blood transfusion banks and health care facilities in general is the ratio of the cross-matched red blood cell (RBC) units, and the number of transfused RBC, known as cross-match to transfusion ratio (C:T). The objective of this research was to provide an assessment of the quality of our work in a cross-sectional study, showing C:T ratios for certain areas of surgery or particular surgical indications. Methods We analyzed the data related to the activities of the Department for Pre-Transfusion Testing and Blood Distribution at the Blood Transfusion Institute of Serbia during the September and November of 2017 period. In total, 341 patients were included in the study, for whom 1,067 RBC units were requested. Results In pre-transfusion testing, 562 units were cross-matched and 249 units were transfused. The overall C:T ratio was 2.25. There are variations in C:T by departments. For the departments of abdominal surgery and reanimation, where uncrossmatched RBC units were requested, C:T was < 2. Other departments had C:T > 3 for almost all therapeutic areas. Conclusion Our results show that the C:T ratio ranged 2.02–3.6, indicating the need to reevaluate the protocols based on which the blood is requested according to individual indications, to adequately prepare patients for surgery in order to reduce the risk of possible allogeneic transfusion, and to apply Patient Blood Management protocols, which include the use of alternatives to allogeneic blood transfusion. © 2020, Serbia Medical Society. All rights reserved.

Introduction/Objective Coumarin therapy represents one of the best models for applying pharmacogenetics. The contribution of factors influencing coumarin therapy can vary significantly between ethnic groups, which justifies conducting population-specific studies. The aim of this study was to analyze the influence of the most important genetic factors (VKORC1 and CYP2C9 genes) that affect coumarin therapy in patients from Serbia. Methods A retrospective study involving 207 patients on acenocoumarol therapy was conducted. Genetic analyses were performed by direct sequencing. Influence on acenocoumarol dose of variants (VKORC1, CYP2C9*2, CYP2C9*3) causing hypersensitivity and VKORC1 variants causing resistance to acenocoumarol were analyzed. Multiple regression analysis was used to design a mathematical model for predicting individual drug dosage based on clinical-demographic and genetic data. Results The study confirmed significant influence of the analyzed genetic factors on acenocoumarol maintenance dose. We designed mathematical model for predicting individual acenocoumarol dose and its unadjusted R2 was 61.8. In the testing cohort, our model gave R2 value of 42.6 and showed better prediction in comparison with model given by other authors. In the analyzed patients, nine different variants in the VKORC1 coding region were found. Among carriers of these variants 78% were completely resistant, and it was not possible to achieve therapeutic effect even with high doses of acenocoumarol. Conclusions Population-specific model for prediction individual dose of acenocoumarol, may show advantages over protocols that are used in a generalized manner. Also, VKORC1 variants which cause coumarin resistance should be considered when planning therapy. © 2022, Serbia Medical Society. All rights reserved.