Transfusion-associated circulatory overload (TACO) prevention requires identification of susceptible patients and enactment of appropriate mitigation strategies. We implemented a clinical decision support (CDS) tool at our institution to reduce TACO occurrence by alerting transfusing clinicians to at-risk patients. A CDS tool was designed to screen patient charts for TACO risk factors (age > 60, renal/cardiac impairment and prior TACO) at the time of inpatient blood component ordering through the electronic health record (EHR). The presence of risk factors triggered a Best Practice Advisory (BPA) pop-up featuring mitigation strategies. TACO rates and frequencies were compared pre- and post-BPA implementation using a Z-test. TACO as a proportion of transfusion reactions decreased 40% from 9.6% (406/4208) to 5.8% (47/804) in the 941 days after BPA implementation (z = 3.44, p = 0.00056). TACO frequency decreased 44% from 1 of 11.2 days to 1/20.0 days post-BPA (z = 4.00, p < 0.00001), while overall reaction frequency decreased 8% from 1 of 1.08 days to 1 of 1.17 days (z = 7.31, p < 0.00001). Among 47 post-BPA TACO events, 38 were subjected to the CDS algorithm, with the BPA firing for 4 of 36 (11%) of cases with TACO risk factors. TACO rates decreased at our institution following BPA implementation, despite BPA under-firing. Ongoing monitoring for BPA sustained effects is needed.
Precise orientation of symmetry-mismatched epilayers on van der Waals (vdW) substrates via heteroepitaxy has commonly been achieved through surface treatment processes to accommodate weak interlayer registry and bonding strength, thereby limiting the range of material combinations for heterostructure design. In this study, we investigate the influence of lattice instabilities in a structurally modulated vdW TaCo2Te2 substrate on the growth and alignment of a symmetry-mismatched bulk CoxTey epilayer using in situ heating in a transmission electron microscope (TEM). We show that a Peierls-like lattice instability occurs in TaCo2Te2 at a transition temperature of ∼523 K, which was corroborated by phonon calculations. Postheat-treated samples reveal a thermally induced surface diffusion process and the dominant lateral growth of the CoxTey epilayer on the TaCo2Te2 vdW layers, as observed in cross-sectional TEM images. Temperature-dependent selected area electron diffraction (SAED) patterns reveal that the quasi-vdW CoxTey/TaCo2Te2 heterointerface acquires directional locking by aligning larger interlayer lattice mismatch along the lattice instability axis of TaCo2Te2, while preserving a strong lattice matching along the orthogonal direction. This heterostructure exhibits precise interlayer registry with one-dimensional lattice incommensuration along the lattice instability axis, resulting from structural distortion to accommodate lattice-mismatch strain. Moreover, the interfacial reconstruction of TaCo2Te2 back to the distorted phase stabilizes the lattice-locking of the quasi-vdW heterointerface at elevated temperatures. These findings encourage the expansion of material diversity for designing and predicting multidimensional heterostructures by leveraging lattice instabilities to guide epitaxy.
The HLA-A*24:677 allele differs from HLA-A*24:02:01:01 by a single non-synonymous nucleotide change in exon 2.
Human parvovirus B19 (HB19V) infection poses significant clinical challenges in resource-limited settings, particularly regarding blood safety surveillance and diagnosis of associated syndromes. Limited access to validated diagnostic assays restricts clinical management and transfusion safety protocols. The objective is to develop and validate an in-house duplex real-time PCR assay for HB19V detection and evaluate its clinical utility in a resource-limited setting. A duplex real-time PCR assay targeting the conserved NS1 gene of HB19V with RNase P as endogenous control was developed. Analytical validation assessed amplification efficiency, limit of detection (LOD), precision (intra- and inter-assay coefficients of variation), and cross-reactivity. Clinical validation compared qualitative agreement with a CE-certified commercial kit using Cohen's kappa statistic. Positive samples underwent Sanger sequencing for genotype characterization. Clinical specimens from suspected HB19V infections were tested and results correlated with patient presentations. The assay demonstrated 98.82% amplification efficiency with LOD of 6 copies/µL. Precision metrics showed excellent reproducibility (CoV < 1% intra-assay, < 5% inter-assay) with no cross-reactivity. Qualitative agreement with the commercial reference was 100% (Cohen's kappa > 0.95). Clinical application identified three significant cases: post-transfusion HB19V in neonatal bilirubin encephalopathy, HB19V consideration in severe anaemia with ventriculitis, and active infection in paediatric Ewing sarcoma with chemotherapy-induced cytopenias requiring IVIG therapy. Genotyping revealed genotypes 1a and 3, confirming regional viral diversity. This validated in-house duplex real-time PCR assay provides a cost-effective, locally sustainable diagnostic tool for HB19V detection. It addresses critical gaps in blood safety surveillance and expands diagnostic capacity for HB19V-associated syndromes in resource-limited settings, while highlighting the necessity of contextual clinical interpretation for optimal patient management.
Human T-lymphotropic virus type 1 (HTLV-1) infection is associated with a broad spectrum of neurological manifestations, including conditions that may precede the development of HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP). This analytical, descriptive cross-sectional study aimed to estimate the prevalence of HTLV-1 infection and describe associated sociodemographic, socioeconomic, behavioral, and clinical characteristics among patients with neurological disorders followed at a tertiary public hospital in Northeast Brazil between 2024 and 2025. A total of 300 patients underwent serological screening using an enzyme-linked immunosorbent assay (ELISA) with a commercial kit (DiaSorin Murex HTLV-1 + 2). Samples with positive or indeterminate results underwent DNA extraction and molecular confirmation by polymerase chain reaction (PCR) to differentiate viral types. Three patients tested positive for HTLV-1, resulting in an overall prevalence of 1.0%. All HTLV-1-positive individuals were women aged 43 to 72 years with low educational attainment and income. Univariate analyses identified significant associations with injection drug use, history of blood transfusion, and family history of HTLV-1 infection. Clinically, HTLV-1-positive patients presented heterogeneous neurological manifestations, ranging from urinary dysfunction and lower limb sensory and motor impairment to musculoskeletal and inflammatory symptoms. These findings highlight the broad spectrum of neurological involvement associated with HTLV-1 infection. Early identification of HTLV-1 may contribute to improved clinical management and inform public health strategies.
Lassa fever is a potentially fatal viral hemorrhagic disease caused by a ribonucleic acid (RNA) virus of the Arenaviridae family, endemic in West Africa. It is highly virulent and contagious in several countries, with a nonspecific clinical presentation that poses a major public health challenge. An in-depth investigative survey was conducted in N'Zérékoré to identify the transmission chain of a confirmed case of Lassa fever. This study reports a confirmed case of Lassa fever diagnosed 13 days after the onset of persistent fever. The disease was suspected at the regional hospital of N'Zérékoré following the worsening of the initial clinical picture, characterized by the onset of hemorrhagic manifestations and failure of antibiotic therapy. Confirmation of Lassa virus infection by reverse transcriptase-polymerase chain reaction (RT-PCR) on a blood sample was obtained a day prior to the patient's death. The patient did not receive ribavirin treatment and remained on the same antibiotic regimen (ceftriaxone) from the onset of fever, combined with dexamethasone, omeprazole, and a unit of blood transfusion. The therapeutic pathway of this confirmed Lassa fever case in N'Zérékoré highlights the need for improved management of viral hemorrhagic fevers and consideration of differential diagnoses when broad-spectrum antibiotic therapy fails.
Identification of five new HLA alleles by next-generation sequencing.
Interpretation of antibody identification panels remains a manual, expertise-intensive step in transfusion testing; interpretive errors and long turnaround times persist even in well-equipped hospitals. Existing commercial software is closed source and often omits enzyme-phase, cold-phase, and dosage-sensitive exclusion rules, limiting third-party verification and local adaptation. We developed IrregulAB, an open-source (LGPL) web application that encodes serologic decision rules in two stages. First, a rule-based screening stage applies LISS, enzyme, and cold rule-out logic with safeguards for antigen dosage in heterozygotes to discard antibodies incompatible with the observed reaction pattern. Second, a minimal-set solver exhaustively searches for the smallest antibody combination(s) that reproduce all assessable reactions and reports all equally plausible solutions. The system was evaluated on 108 development antibody-identification panels and 35 held-out temporal validation panels. The screening stage retained the complete reference antibody set in 93% of development panels and 91% of held-out temporal validation panels. The minimal-set stage produced at least one valid explanatory antibody combination in 87% of development panels and 89% of held-out temporal validation panels. IrregulAB is a transparent, rule-based decision-support tool for trained immunohematology personnel; it is not an autonomous antibody-identification or reporting system. By exposing every encoded decision rule, it enables independent verification, local tuning, and more standardized review of routine antibody workups under expert supervision. Its current performance was evaluated retrospectively in a single-center Bio-Rad gel-card dataset; multicenter and multi-platform validation is required before wide clinical implementation.
Beta-thalassemia (β-Thal) is an inherited hemoglobin disorder caused by defective β-globin synthesis, resulting in ineffective erythropoiesis, chronic hemolytic anemia, and altered iron metabolism; it is highly prevalent in Iraq, a country with a complex and not fully characterized immunological profile. Inflammatory cytokine dysregulation in transfusion-dependent patients further compromises hematopoiesis, drives progressive iron overload, and perpetuates immune activation. This study aims to compare the gene expression and protein levels of seven cytokines - IL-1β, IL-4, IL-5, IL-12, IL-13, IL-17F, and TNF-α - between patients with beta-thalassemia and healthy controls. This case study included 344 patients with beta-thalassemia and 440 healthy patients of the same age and gender that were collected from Maysan (Al-Amarah) and Najaf, Iraq. The mRNA expression levels were assessed using quantitative real time polymerase chain reaction (qPCR) and included GAPDH as the internal reference gene for all assessments done. The levels of cytokines present in the serum were determined using ELISA method. The statistical tests that were included are: independent samples t-test, Pearson correlation, receiver operating characteristic (ROC) curve, and binary logistic regression. For all of the patients that showed the presence of IL-1β, there was a significant elevation in the mRNA and serum protein levels of IL-12, IL-17F, and TNF-α. The results showed a decrease in the presence of IL-4, IL-5, and IL-13. For all patients, TNF- α showed the greatest ability to diagnose a case of beta-thalassemia (AUC = 0.961). There was a significant positive correlation with serum ferritin, the number of blood transfusions, and splenomegaly. Pro-inflammatory cytokines TNF-α and IL-1β demonstrated the strongest positive correlations with serum ferritin (r = 0.798 and r = 0.714, respectively), transfusion frequency, and splenomegaly. Conversely, Th2 cytokines IL-4 and IL-13 showed significant inverse correlations with ferritin and positive correlations with hemoglobin, reflecting progressive Th2 suppression with increasing disease burden.
Accurate and early screening of acute myeloid leukemia (AML) is critical for timely intervention and improved patient prognosis. This study presents a self-powered dual-mode biosensing platform for the ultrasensitive detection of AML-associated fusion gene UBA2-WTIP. The platform innovatively integrates a AuNPs/MoS2-graphdiyne (GDY) heterojunction as a high-performance substrate, a structurally stable three-dimensional hexahedral DNA nanopillar as a molecular scaffold, and a cascaded signal amplification strategy driven by target-triggered rolling circle amplification (RCA) and DNAzyme walker-mediated hybridization chain reaction (HCR). The Au/MoS2-GDY heterojunction provides an efficient conductive network that facilitates rapid electron transfer, significantly enhancing the output signal. The engineered hexahedral DNA nanostructure offers abundant binding sites and superior stability for subsequent nucleic acid assembly. Upon target recognition, protect DNA is displaced, activating RCA process to generates long DNA strands containing numerous DNAzyme units. These DNAzymes, in the presence of Mg2+, cleave substrates to release initiator strands, which in turn trigger an autonomous HCR on the electrode. This cascade results in the in situ formation of extended dsDNA polymers, which entrap the electrochromic molecule methylene blue, producing easily measurable electrochemical response and distinct color change. The proposed biosensor demonstrates a wide linear range from 0.1 fM to 10 nM for UBA2-WTIP, with low detection limits of 27.7 aM (electrochemical) and 49.4 aM (colorimetric) (S/N = 3), alongside built-in self-verification and correction for enhanced reliability. This work establishes a powerful and reliable sensing strategy, highlighting the great potential of integrated DNA nanotechnology and bioenzyme-based biofuel cells for the early diagnosis of hematological malignancies.
Hydrogen peroxide (H₂O₂) plays a crucial role in both biological and industrial systems. Excessive H₂O₂ can lead to oxidative stress, cellular damage, and process-related issues in manufacturing. For this reason, fast and sensitive detection methods are needed. In this study, Ni-CoWO₄ nanoparticles, belonging to the bimetallic nanozymes family, were used as catalysts to promote the oxidation of ortho-phenylenediamine (OPD) by H₂O₂. Polyoxometalates are renowned for their structural diversity, large surface area, and robust redox activity, making them exceptional candidates for catalytic applications. Ni-CoWO₄ was prepared using a hydrothermal method and characterized using SEM-EDX, XRD, and FT-IR techniques. The nanoparticles exhibited an even distribution of nickel and cobalt within a multi-metallic framework, resulting in numerous active sites and a high surface-to-volume ratio. Compared to the system without the catalyst, Ni-CoWO₄ significantly improved the reaction rate, produced a stronger yellow color, and reduced the oxidation time. The reaction was monitored by visible spectrophotometry, spectrofluorimetry, and smartphone-based colorimetry. A linear range of 0.5-150 µM and a limit of detection of 485 nM for H2O2, and a linear range of 1-125 µM for glucose were obtained by the spectrophotometry. In spectrofluorimetry, it showed a linear range of 0.1-50 µM, and LOD was 64 nM. In the smartphone-based method, RGB (Red, Green, Blue) and CMYK (Cyan, Magenta, Yellow, Key (Black)) were used for colorimetric and fluorimetric determination. Overall, the results demonstrate that Ni-CoWO₄ is a low-cost and effective nanocatalyst for H₂O₂ and glucose sensing, with significant potential for both biological and industrial applications.
Massive transfusion protocols are essential in trauma resuscitation but may inadvertently increase the risk of acute hemolytic transfusion reactions (AHTRs), which are typically caused by ABO incompatibility. Recognition is difficult because signs of hemolysis can mimic trauma-related hemorrhage or coagulopathy. Cognitive biases in emergency decision-making may further delay diagnosis. Although ABO-incompatible AHTR remains exceptionally rare in trauma, it is easily overlooked in the context of polytrauma. We describe three cases of ABO-incompatible AHTR admitted to a tertiary trauma center. First, a 52-year-old man with multiple injuries received three mis-issued AB+ units instead of group O blood. He developed hemoglobinuria, coagulopathy, and fatal multiorgan failure. The second case involved an 81-year-old man with multiple comorbidities who underwent hip fracture fixation; due to a mislabeled admission sample, he received A+ instead of B+ blood, resulting in persistent anemia, renal failure, and death. The third case was a 30-year-old woman with severe head and thoracic trauma who received incompatible blood under an emergency release protocol. She developed hemolysis, neurologic decline, and sepsis, and ultimately died of multiorgan failure. In all three patients, early post-transfusion anemia and hemodynamic instability were attributed to trauma, delaying recognition of hemolysis. AHTR may therefore be overlooked in trauma settings, where its manifestations overlap with injury-related complications and cognitive biases such as anchoring and premature closure may impair diagnostic reasoning. Strict transfusion safety protocols, heightened vigilance when hemoglobin levels fail to rise, and awareness of cognitive errors may improve early recognition and patient outcomes.
The tumor suppressor gene TP53 produces multiple p53 protein isoforms through alternative promoter usage, messenger RNA splicing, and alternative translation initiation. These isoforms can differentially shape canonical p53 outputs, including cell-cycle arrest, senescence, apoptosis, and DNA-damage responses, and are increasingly recognized as context-dependent regulators of tumor progression and treatment response. However, their roles in hematological malignancies remain incompletely characterized. This review summarizes the structure, biogenesis, and functional consequences of p53 isoforms and integrates available evidence on their expression across acute leukemias, multiple myeloma, chronic lymphocytic leukemia, and selected non-Hodgkin lymphomas. We highlight reported differences between diagnostic and relapse specimens, associations with cytogenetic risk categories, and interactions with TP53 mutation backgrounds. Available data suggest that N-terminally truncated isoforms (Δ40p53, Δ133p53/Δ160p53) and C-terminally spliced variants (p53β/γ) can modulate tetramer composition and downstream transcriptional programs, thereby influencing apoptosis, senescence, and DNA repair. However, the clinical significance of these patterns in hematological malignancies remains incompletely defined because the evidence is derived from relatively small and methodologically heterogeneous studies. More standardized assays and prospective validation in larger, clinically annotated cohorts are needed before p53 isoform profiling can be incorporated into routine risk stratification or therapeutic decision-making. We also discuss methodological advances and limitations in isoform detection at transcript and protein levels, including isoform-specific quantitative reverse-transcription polymerase chain reaction, antibody panels, capillary nanoimmunoassays, and targeted liquid chromatography-tandem mass spectrometry. Comprehensive profiling of p53 isoforms may eventually help refine biological classification and risk assessment, but its clinical utility will depend on assay standardization and prospective validation.
The anti-f antibody is rarely encountered in the immunohematology laboratory. It is against the compound antigen "ce" or "f." The "f-"antigen is only expressed when both c and e alleles are present in the cis position on the same haplotype. Anti-f is a clinically significant antibody that can cause hemolytic transfusion reaction and hemolytic disease in fetuses and newborns. Herein, we report two cases of anti-f antibodies in a 12-year-old boy with a background of bicytopenia and in an 82-year-old male patient with non-Hodgkin lymphoma. In the first case, it was an allo-anti-f associated with a warm type of autoantibody, and the second patient was suspected to have auto-anti-f. The direct antiglobulin test was positive in both cases. Both patients were transfused with c-antigen-negative compatible red cell units without any adverse reactions. This report highlighted the fact that units negative for the c-antigen are a more conservative choice for transfusion than units negative for the e-antigen as both c- and e-antigen-negative units are extremely difficult to find in the general population.
Trauma Registries with a focus on severely injured patients use survival as their primary outcome. In order to compare hospitals, interventions, and changes over time, a precise risk of death prediction is mandatory. The German TraumaRegister DGU® uses the RISC II model (Revised Injury Severity Classification, version II) since 2013. The aging trauma population and an improved handling of missing data required the present revision. A total of 53,738 seriously injured trauma patients documented in 2022-2023 served as basis for development and validation (3:1 ratio). Missing values should now be considered to be within normal physiological range except in patients with specific findings indicative for an altered physiology. These findings were suggested by clinical experts and validated by registry data. The increasing age of trauma patients was addressed by additional categories and higher point weights. A logistic regression analysis provided new point weights for all predictors. Precision (observed versus predicted mortality) and discrimination (area under the receiver operating characteristic curve, AUROC) were calculated in the development and validation dataset. Patients in both datasets were well comparable, with a mean age of 55 years, 69% males, and an average Injury Severity Score (ISS) of 18 points. The rate of missing values ranged from 0% (compulsory data) to 17.5% (initial base excess). Missing pre-injury health status was imputed by age, missing pupil size, light reaction, and motor function were imputed by severity of head injury. In case of specific findings, blood pressure and initial laboratory values were imputed by injury severity (ISS), or blood transfusion, or catecholamines, or intake of anticoagulation drugs. The AUROC was 0.946 (95% confidence interval 0.944-0.949) for the new RISC III score which was confirmed in the validation data (0.949; CI 0.945-0.954). Observed and predicted mortality were 13.1% / 13.0% in the development dataset, and 13.2% / 13.0% in the validation dataset. Risk of death estimates require repeated validations. The increasing number of elderly trauma patients, some of them with restrictions regarding the intensity of treatment, required this update of the RISC II model. New point weights for age were established now, especially for the elderly, in order to enhance the precision of prediction in this patient group. Patients with missing values showed on average a low injury severity, thus replacing a missing value with the normal category as a general rule (RISC III) seems to be superior than replacing it with an average value (RISC II). The new prediction model shows high discrimination and precision in both datasets, development and validation, and will replace the previous version in quality reports and scientific analyses.
Characterisation of seven novel HLA class I alleles.
To evaluate the effectiveness of a clinical decision support system in improving management of the entire blood transfusion process using a retrospective before-and-after comparative study. A closed-loop transfusion decision support system was developed and implemented hospital-wide in 2020 following a 1-month pilot. Outcomes before implementation (Jan 2018-Jun 2020) and after implementation (Jul 2020-Dec 2022) were compared, including documentation quality and completeness, documentation time, nursing satisfaction, and transfusion adverse events. After implementation, completeness of transfusion records increased from 97.1% to 99.1% (P < 0.05). Documentation time significantly decreased and nursing satisfaction significantly improved (both P < 0.001). A statistically significant difference was observed in the reported incidence of transfusion adverse reactions between the pre- and post-implementation periods (χ2 = 9.41, P < 0.05; OR = 1.39, 95% CI: 1.13-1.73). The system standardizes transfusion management, improves documentation completeness, reduces nursing workload, and enhances management of transfusion reactions.
Sepsis often has a dysregulated inflammatory response and is accompanied by cardiac dysfunction. This study aimed to explore the mechanism of long non-coding RNA MIR503HG (MIR503HG) in regulating sepsis and the inflammatory responses, and sepsis-induced cardiac dysfunction (SICD). 102 sepsis patients were divided into an SICD group (n = 31) and a non-SICD group (n = 71). A cecal ligation and puncture (CLP) sepsis rat model was constructed. Quantitative reverse transcription polymerase chain reaction (RT-qPCR) was used to evaluate the target gene expression. Enzyme-linked immunosorbent assay was used to measure the levels of myocardial damage markers and inflammatory factors. RNA immunoprecipitation and Dual luciferase assay were used to determine the targeting relationship. Kyoto Encyclopedia of Genes and Genomes analysis was used to predict signaling pathways of target genes. MIR503HG expression was significantly down-regulated in sepsis patients and SICD patients, and it has good diagnostic value for these two types of diseases. Its expression was significantly negatively correlated with myocardial injury markers (cardiac troponin I [cTnI], creatine kinase-MB [CK-MB]), cardiac function indicators (left ventricular ejection fraction), inflammatory factors (interleukin-6, tumor necrosis factor-alpha), and disease severity scores (Sequential Organ Failure Assessment, Acute Physiology and Chronic Health Evaluation II). Furthermore, it exerted a protective effect in sepsis: MIR503HG overexpression could effectively alleviate SICD and mitigate the inflammatory response, as evidenced by decreased left ventricular end-diastolic pressure, increased left ventricular systolic pressure, reduced levels of CK-MB and cTnI, as well as restored myocardial systolic/diastolic capacity (maximal rate of left ventricular pressure rise/fall [±dP/dt]). Mechanistically, MIR503HG functions as a molecular sponge that sequesters microRNA-497-5p (miR-497-5p), thereby lifting brain-derived neurotrophic factor (BDNF). Delivery of miR-497-5p-agomiR partially offset the cardioprotective and anti-inflammatory effects of MIR503HG, whereas overexpression of BDNF partially restored them. MIR503HG relieved sepsis and reduced cardiac dysfunction and inflammatory response by regulating the miR-497-5p/BDNF axis.
Although the highly prophylactic precautions and measures for keeping safe blood transfusions, transfusion-transmitted infections (TTIs) still constitute a remarkably significant risk in medicine. Few documents recorded the situation of TTIs in Dera Ismail khan (D.I. Khan) district, Pakistan so this study aimed to assess the prevalence of TTIs among blood donors in the district, to update and enhance the management of a secure blood supply. A cross-sectional observational study was conducted at the Regional Blood Centre in D.I. Khan, encompassing all eligible blood donors over three months. Screening for hepatitis B virus, hepatitis C virus, human immunodeficiency virus, and syphilis was performed by using chemiluminescence immunoassay, while malaria parasite testing was performed by immunochromatographic technique. The results revealed that a total of 1221 people had attended the Regional Blood Center in D.I. Khan for blood donation. Only 1129 (92.46%) individuals were permitted to be screened as pre-donation scanning measures for TTIs, while the rest had medical histories that prevented them from donating. Out of 1129, eight (0.7%) were only females, and 1121 (99.29%) were males. The majority of donors, 550 (48.9%), were aged 30 years or younger. The number of voluntary donors, 87 (7.7%), was lower than the number of professional paid donors, 1042 (92.3%). The prevalence of TTIs among all donors was 60 (5.31%). The prevalence of syphilis, HBV, HCV, HIV, and malaria were 1.94%, 1.50%, 1.32%, 0.35%, and 0.17%, respectively. The infection rates among positive donors were notable for syphilis 22 (36.66%), hepatitis B 17 (28.0%), hepatitis C 15 (25.0%), HIV 4 (6.66%), and malaria 2 (3.33%). Professional paid donors showed slightly higher rates of TTIs 57 (5.47%) than that among voluntary donors 3 (3.44%). The study reflected the high prevalence of TTIs among blood donors in D. I. Khan, Pakistan. It also emphasized the role of blood screening, where the most prevalent TTIs were syphilis, HBV, HCV, HIV, and malaria. Encouraging voluntary blood donors and health education provide the community with safer blood with a higher quality.
To report a case of dengue fever complicated by acute acalculous cholecystitis (AAC) and hemophagocytic lymphohistiocytosis (HLH), despite initial negative polymerase chain reaction (PCR) results. We describe the clinical course of a 40-year-old woman who returned from Indonesia with a persistent fever and rash. The diagnosis was established through clinical evaluation, serological testing, and abdominal imaging. The study conformed to the principles outlined in the Declaration of Helsinki. Although the initial dengue PCR result was negative, subsequent NS1 and IgM antibody test results were positive. The patient developed severe complications, including AAC, characterized by gallbladder wall thickening, and HLH, indicated by marked fever, splenomegaly, hypofibrinogenemia, hyperferritinemia, and high soluble IL-2 receptor levels. Despite these symptoms, the patient was managed conservatively. Planned percutaneous transhepatic gallbladder aspiration was canceled because of spontaneous improvement observed on ultrasonography. The patient recovered fully without corticosteroid or platelet transfusions and was discharged on day 14. Given the potential for false-negative PCR results during the acute phase of dengue, multimodal serological testing is essential. This case demonstrates that severe atypical complications, such as AAC and HLH, can be resolved with supportive care alone, avoiding invasive procedures, immunosuppressive therapy, and platelet transfusion.