Dr. Donovan McGrowder

Cardiac surgery remains associated with a significant risk of postoperative bleeding. This risk is accompanied by increased morbidity and mortality, as is any associated transfusion. Bleeding has been reduced in recent years because of advances in surgical technique and improvements in the management of the coagulopathy associated with cardiopulmonary bypass. Thromboelastometry is a whole blood assay performed to evaluate the viscoelastic properties during blood clot formation and lysis. Point-of-care testing, including thromboelastometry, has been used to support a more rational approach to the management of significant postoperative bleeding. This has resulted in a reduction in the use of clotting products after cardiopulmonary bypass. In an article published in Journal of Cardiothoracic and Vascular Anesthesia, Dr. McGrowder and colleagues in the Departments of Haematology, Research and Development, and Anaesthetics at Royal Brompton Hospital, London, United Kingdom carried out a prospective observational study with fifty-eight adult male and female patients undergoing primary coronary artery revascularization.

RESULTS OF THE STUDY

The key finding of the study is that while postoperative ROTEM thromboelastometry had a reasonable positive predictive value, its negative predictive value was 100% for the prediction of bleeding in the early postoperative period. This has led to the routine use of ROTEM thromboelastometry at the Royal Brompton Hospital. Other studies have reported that a major benefit of ROTEM thromboelastometry is the quick detection of a developing coagulopathy already during cardiopulmonary bypass. It is hoped that this method which is used in many hospital in the United States and Europe will be implemented in hospitals in the Caribbean in the near future.

Dr. Donovan McGrowder and team
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IRON DEFICIENCY- A COMMON CLINICAL PROBLEM

Iron deficiency is a common clinical problem. The correct diagnosis of iron deficiency is essential for successful patient management because it may be the presenting sign of a serious illness such as a gastrointestinal malignancy. In many cases, iron deficiency is relatively simple to diagnose and treat. However, in some patients with medical problems such as infection, inflammation and malignancy, the diagnosis can be difficult. Measurement of serum ferritin is currently the accepted laboratory test for diagnosing iron deficiency. Other commonly used laboratory tests such as serum iron, total iron binding capacity, mean corpuscular volume, and transferrin saturation provide little additional diagnostic value. In an article published in Clinica Chimica Acta, Dr. McGrowder and colleagues at the University of the West Indies and Department of Clinical Biochemistry, Royal Brompton Hospital, London, United Kingdom investigated the clinical utility of soluble transferrin receptor in the assessment of iron status in adult patients with cystic fibrosis.

IMPORTANT FINDINGS AND FURTHER STUDY

Publications from Dr. Donovan Mcgrowder
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The authors found that iron status of patients with cystic fibrosis can be accurately assessed by soluble transferrin receptor which is unaffected by the acute phase response. The prevalence of iron deficiency anaemia in the Caribbean differ from place to place, and observed rates ranging from 27 to 75% in pregnant women, 19 to 55% in lactating women and 15 to 80% in young children have been reported. In Jamaica, the prevalence of iron deficiency anaemia in children is estimated at about 30%. Further studies will be done to identify patients with iron deficiency anaemia in these different groups using soluble transferrin receptor.

OTHER PUBLICATIONS

Other articles by Dr. McGrowder during the academic year were published in: Archives of Medical Sciences, Journal of Medical Biochemistry, Journal of Rural and Remote Health, Journal of the Royal Society for the Promotion of Health, and Open and Geriatric Medicine Journal.