Septic Arthritis

Septic Arthritis is also known as bacterial arthritis and is a condition caused by bacterial infection of the joint space. The infection may be located at the affected joint or may have traveled through the bloodstream. Micro-organisms such as Staphylococcus aureus, Streptococcus pneumoniae, and group B streptococci are often the cause for this form of arthritis. This medical condition must be treated immediately lest it destroy the affected joint. The knees and hip are most often affected by septic arthritis. But sometimes the shoulder, wrist, elbow or ankles are affected. Often septic arthritis is noticed in persons who have had traumatic injury to the joint or fitted with an artificial joint. Diabetes and rheumatoid arthritis can put a person at higher risk for septic arthritis. Poor immune system and intravenous drug abuse are other conditions that put a person at additional risk of contracting septic arthritis. Septic arthritis manifests with symptoms such as intense joint pain and swelling of the affected joint. Swelling on the affected joint makes it very tender and redness is noticed. Low grade fever is also noticed.

Aspiration of synovial fluid and its culture helps in diagnosing septic arthritis. X-rays may not help in detecting this form of arthritis in the early stages. Draining the increased synovial fluid from the affected joint can help in relieving pressure and reduce symptoms of septic arthritis. The damage to the affected joint can be arrested once the fluid is drained. Blood tests can help in prescribing the right antibiotics to find the type of bacteria that is causing the infection. In the early stages of treatment, the antibiotics are directly injected into the vein. But the antibiotic treatment must be continued till the infection is completely eliminated. While warm compresses and elevation gives some relief to a person suffering from septic arthritis, rest will also do good. The affected joint may be rehabilitated with supportive exercises.

Blood Transfusion

Blood transfusion is one of the important procedures administered in healthcare centers to meet surgical and trauma needs. This procedure is categorized under transfusion medicine section. Blood transfusion is a high-risk procedure as it involves multiple protocols and guidelines for safe and effective transfusion.

Guidelines and Procedure

Transfusion medicine has high significance as it involves the transfusion of blood and blood products depending upon the patient needs. Blood required for the transfusion is obtained from blood banks, which are established either by the government or privately following NCCLS standards for the blood banks. The standards are evaluated by organizations such as WHO to set a uniform and global protocol for safe transfusion. Blood transfusion is predominantly done to increase the percentage of hemoglobin in anemic patients and also to replace vital components such as platelets and serum proteins in some medical conditions. Other reasons for blood transfusion is to replace the amount of blood lost during surgery or trauma. Patients suffering thrombocytopenia (any disorder in which there is an abnormally low amount of platelets) might be in need of platelet transfusion.

Blood banks are authorized by the government to collect blood of different groups. Some of the rare groups include B negative, O negative and Bombay blood group. In these situations, the names and the address of these respective rare blood types are noted to ensure timely availability in case of a transfusion request. Cancer patients also require transfusion in case of conditions such as leukemia and malignant carcinomas associated with spleen or bone marrow. Leukocyte reduction procedure is followed in some transfusion centers in order to minimize the incidence of transfusion-associated allergic reactions. All donors are checked for a three-month gap before the subsequent transfusion to facilitate fresh blood collection from the donors containing viable red blood cells.

Different types of Blood transfusions:

Fresh Whole Blood: This is mostly needed during cardiac surgery or massive hemorrhage. Fresh Whole blood has RBC, plasma and fresh platelets.

Packed RBC: This is mostly needed to raise the hematocrit (the proportion of total blood volume that is composed of red blood cells).

Frozen packed RBC: Stored for nearly 3 years, frozen packed RBC is sparingly used. It is often used for rare blood groups. Patients suffering severe leukoagglutinin reactions or anaphylactic reactions might need this.

Leukocyte-Poor Blood: Patients who suffer severe leukoagglutinin reactions might need this. It is an expensive process as WBC are removed by centrifugation.

Precautions and risks

Transfusion is a very important procedure and hence primary analysis of the donor blood is done in order to avoid blood borne sepsis, transfusion allergies and organ damage. The donor blood is always cross-matched with the recipient's in order to check the compatibility of the blood. All procedures are documented to ensure safety and tracking of a transfusion procedure, as it is associated with medico-legal protocols. The A and B antigens are the first check before transfusion. In emergencies, type O/Rh-negative blood can be given to any recipient and usually packed cells are given. The Rh factor has also to be tested. Blood from the donor is also investigated for infections such as HIV 1&2, HBV, HCV, and VDRL to ensure safe transfusion.

Blood is collected from the healthy donor in a blood bank by administering venipuncture procedure from the brachial region. The obtained blood is transported for immediate need in surgeries or stored for few days in case of a scheduled surgery having the requirement for the particular blood group. The transfusion requirement is clearly stated in the surgical form and the blood bank technicians provide number of units required on the given date. Some of the common side effects associated with blood transfusions are infections of both viral and bacterial origin obtained from an infected donor. Receipt of blood contaminated with gram-negative bacteria often causes septic shock, Disseminated intravascular coagulation or DIA (a large amount of procoagulant enters the blood stream over a short period of time, overwhelming the body’s ability to replenish coagulation factors and causing bleeding) and acute kidney injury. Receipt of blood with gram-positive bacteria causes fever and Bacteremia (presence of bacteria in blood) but rarely causes sepsis.

Pulmonary Infarction

Infarction means 'tissue death' in medical terminology. It is caused by obstruction of blood supply to the tissue leading to lack of oxygen. Infarct, which refers to the resulting lesion is derived from Latin, 'infarctus' which means 'stuffed into'. Pulmonary infarction refers to the death of a small area of lung resulting from pulmonary embolism. It occurs in a small, dead end pulmonary artery.

How does pulmonary infarction occur ?

Pulmonary infarction results from free floating thrombus, when many material substances including fat, tumor, septic emboli, air, and amniotic fluid and injected foreign material may form an emboli and move to the pulmonary circulation. In other words, plugging of a branch of the pulmonary artery by a clot (thrombosis) or by a piece of clot carried by the blood stream to the lung from a thrombus located elsewhere can result in pulmonary infarction. The involved area of the lung ceases to function and complication of the thrombosed veins leads to heart disease.

Causes of pulmonary infarction

The most common cause of pulmonary infarction is pulmonary embolism, but there are other conditions which can cause pulmonary infarction including cancer, and autoimmune diseases such as lupus. Sometimes, this condition may occur following a surgery. Other underlying conditions especially in children with pulmonary emboli include sickle cell disease, nephrotic syndrome, chemotherapy and Inherited hyper coagulable state and Vasculitis.

Symptoms of pulmonary infarction

Symptoms associated with pulmonary infarction include shortness of breath, chest pain, and blood sputum or hemoptysis. Sudden piercing pain in the chest which often radiates to the shoulder is noticed. Difficulty in breathing, irritating cough and blood tinged sputum are other signs. Persistent hiccups are present. Most often the patient is anxious with a rapid pulse, sweats profusely and has an elevated body temperature. In some severe cases, the patient may be in a state of shock.

Diagnosis of pulmonary infarction

Reflex broncho constriction is often associated with pulmonary embolism. Increased breathing and decreased pulmonary compliance with diminished surfactant levels may occur due to pulmonary infarction. This contributes to increased work of breathing and diminished oxygen levels. In sickle cell disease, there is sickling of RBCs within the small blood vessels of the lungs due to dehydration as a result of fever, Tachypnea (rapid breathing) and decreased intake, which can precipitate in a cycle of relative de oxygenation that further exacerbates the sickling tendency. Many also suffer a component of reactive airway disease and oxygenation is further decreased due to this factor.

Morbidity may include pulmonary hypertension, right ventricular failure and Cor Pulmonale, paradoxical embolization in patients with intracardiac defects, and sometimes side effects of medications used to treat pulmonary embolism. If pulmonary embolism is large, there could develop right ventricular strain and right heart failure as there is sudden increase in pulmonary artery pressure leading to right heart failure. A sudden pressure in the right ventricle can cause a leftward shift of the intraventricular septum, which may result in a classic obstructive shock, thereby impairing left ventricular filling.

Treating pulmonary infarction

It is timely treatment that is vital. If symptoms of pulmonary infection develop while at home, consult a physician at once. In case, shock develops, it is essential to get first aid treatment. Many times, patients are already in the hospital when pulmonary infarction occurs. Administration of oxygen, use of anticoagulants and prevention of infection are some other suggested line of treatment. Surgery may also be indicated.