In nephrotic syndrome (NS) due to podocytopathies, loss of vitamin D binding globulin along with albumin in urine leads to Vitamin D deficient state. We aimed to study the severity of vitamin D deficiency and its clinical correlation in children with NS. We performed a cross-sectional study at a tertiary care hospital in Northern India. Enrolment of children aged 1–18 years was done. Patient's detailed history, numbers of relapse, treatment details, and data regarding various immunomodulatory drugs treatment. Vitamin D level was estimated, and its status was further classified as deficiency <20 ng/mL and insufficiency 20–30 ng/mL as per Global Consensus Recommendations on evaluation, treatment, and prevention of vitamin D deficiency. Continuous variables were compared using tests such as unpaired t-test, Kruskal–Wallis test, and Wilcoxon rank sum test depending on the distribution of parameters. Categorical variables were compared using Chi-squared tests or Fisher's exact test. A total of 96 children with NS were screened, of which 77.1% had vitamin D deficiency. The mean serum vitamin D level was 14.393 ± 8.52 ng/mL. Among the 48 children of the first episode of NS 36 were deficient (36/48 = 75%). Whereas in the relapse category, 30 patients had infrequently relapsing NS (deficient 24/30 = 80%). Eleven children had frequently relapsing NS; among them, 10 were vitamin D deficient (10/11 = 90.9%), and there was a negative correlation between vitamin D level and duration of illness. Vitamin D deficiency is a common comorbidity in children with NS. Given the putative immunomodulatory property of vitamin D, this deficiency should be identified and treated routinely in all cases of NS.

Background Red blood cell alloimmunisation during the pregnancy is a significant cause for neonatal mortality and morbidity. This study was planned to determine the prevalence and specificity of irregular erythrocyte antibodies in antenatal mothers and their neonatal outcome. Methods In this observational study, blood grouping and red cell antibody screening of mothers were performed at first visit and after 28 weeks of gestation and positive cases were identified and followed up monthly till delivery by repeating antibody titre and middle cerebral artery—peak systolic velocity. After delivery of alloimmunised mothers, cord blood haemoglobin, bilirubin and direct antiglobulin tests (DAT) were analysed and further outcome of neonate was recorded. Results Among 652 registered antenatal cases, 18 multigravida women were found to be alloimmunised, accounting to prevalence of 2.8%. Most common alloantibody identified was anti D (>70%) followed by anti-Le^a, anti-C, anti-Le^b, anti-E and anti-Jk^a. Only 47.7% Rh D negative women received anti-D prophylaxis during previous pregnancies or whenever indicated. DAT was positive in 56.2% of neonates. Among nine DAT positive neonates, two early neonatal deaths due to severe anaemia were observed following birth resuscitation. Four antenatal mothers required intrauterine transfusion in view of fetal anaemia while three neonates received double volume exchange transfusion and top up transfusions after birth. Conclusions This study emphasises importance of red cell antibody screening for all multigravida antenatal women at registration of pregnancy and additionally at 28 weeks or later in high-risk cases irrespective of RhD status.

Roughly a third of surgical patients are found to have preoperative anaemia, with increased prevalence seen in children and the elderly, females, and residents of low-income regions. Perioperative anaemia is independently associated with poorer outcomes in surgery, which warrants a proactive approach to evaluation and management of anaemia. As allogeneic red blood cell (RBC) transfusion is associated with increased risk of infection and many comorbidities in patients, other modalities for treatment of anaemia and mitigation of blood loss should be employed. The appropriate approach to treatment of preoperative anaemia will depend on investigation of the patient’s underlying pathophysiology. The most common cause of preoperative anaemia is iron deficiency. Oral iron supplementation or intravenous (IV) iron, sometimes combined with erythropoiesis stimulating agents (ESAs), can effectively correct iron-deficiency anaemia prior to surgery. Techniques of intraoperative blood conservation, including intraoperative cell salvage and acute normovolemic hemodilution (ANH), along with hemostatic agents can reduce surgical blood loss and limit the need for allogeneic RBC transfusion. Effective care of the postoperative patient requires attention to limiting blood draws, optimizing nutrition, and judicious utilization of pharmacologic agents and blood component therapy. Increasing awareness of patient blood management as an overall approach and growing evidence of improved patient outcomes with blood conservation strategies will likely lead to increased adoption of best practices for management of perioperative anaemia.