[This corrects the article DOI: 10.3389/fneur.2026.1784512.].

X-linked erythropoietic protoporphyria (XLEPP) is a rare non-acute porphyria associated with severe photosensitivity and, in some patients progressive hepatobiliary disease. We describe the perioperative management of a middle-childhood-aged female with XLEPP, end-stage liver disease, portal hypertension-related thrombocytopenia and coagulopathy who required urgent dental extractions to facilitate transplant preparation. Key anaesthetic considerations included avoidance of phototoxic light exposure, safe drug selection, altered pharmacology in liver disease and bleeding risk. Surgery was performed under propofol-remifentanil total intravenous anaesthesia using the hospital's iLED 7 (Baxter Medical Systems GmbH + Co. KG, Saalfeld, Germany) light-emitting diode (LED) theatre lighting system, without additional optical filters or intraoperative light dosimetry. Additional precautions included avoidance of sunlight and fluorescent lighting, theatre-blind closure, occlusive coverings during transfer and recovery, coagulation optimisation, tranexamic acid and meticulous local haemostasis. The patient had no perioperative phototoxic injury, haemodynamic instability or red cell transfusion requirement and was discharged home the following day. This case highlights multidisciplinary planning in rare paediatric photosensitive liver disease.

There is a lack of consistently effective noninvasive treatments for idiopathic renal hematuria (IRH) in dogs. This report describes a dog with IRH that had complete resolution of clinical signs after a 6-week treatment with the antifibrinolytic agent tranexamic acid (TXA). In this dog, macroscopic and microscopic hematuria remained absent after TXA was discontinued. Further, 16 mo later, the owner reported no noted recurrence of macroscopic hematuria. This report provides evidence that oral TXA therapy is a viable, noninvasive treatment option that may help manage some dogs with IRH. Key clinical message: Oral TXA therapy is a potential treatment option for dogs with IRH when other treatment modalities are unsuccessful or not possible.

Hip hemiarthroplasty for femoral neck fractures is often associated with substantial perioperative blood loss and transfusion requirements. Tranexamic acid (TXA) may reduce bleeding, but concerns remain regarding thromboembolic safety. This systematic review and meta-analysis evaluated the efficacy and safety of TXA in hip hemiarthroplasty. PubMed, Embase, and Cochrane were searched from inception to February 2026. Randomized controlled trials and cohort studies comparing TXA with no TXA or no TXA in patients undergoing hip hemiarthroplasty were included. Random-effects meta-analyses were performed to pool risk ratios (RRs) and mean differences (MDs), with subgroup and sensitivity analyses conducted to assess the robustness of the findings. The primary outcome was total blood loss. Secondary outcomes included postoperative haemoglobin, transfusion requirement, mortality, thromboembolic events, surgical site infection, stroke MI and length of hospital stay. Although total blood loss was the pre-specified primary outcome, transfusion requirement was also evaluated as an important secondary outcome because of its direct clinical relevance. Fourteen studies comprising 7,660 patients (3,271 TXA and 4,389 controls) were included. TXA significantly reduced allogeneic transfusion requirements (RR 0.48, 95% CI 0.38-0.61; P<0.001) and improved postoperative day-1 haemoglobin (MD 0.48 g/dL, 95% CI 0.14-0.83; P=0.011). A reduction in 30-day mortality (RR 0.69, 95% CI 0.49-0.96; P=0.029) and length of hospital stay (MD -1.57 days, 95% CI -3.12 to -0.03; P=0.047) was observed, although both findings were sensitive to individual studies and should be interpreted cautiously. Total blood loss was not significantly different between groups (MD -162.73 mL, 95% CI -346.49 to 21.02; P=0.076) because of extreme heterogeneity. TXA was not associated with an increased risk of DVT, PE, MI, stroke, or surgical site infection. No significant differences were observed between intravenous and intra-articular administration. TXA is an effective and safe adjunct in patients undergoing hip hemiarthroplasty. It significantly reduces transfusion requirements and preserves early postoperative haemoglobin without increasing major postoperative complications. Although reductions in 30-day mortality and length of hospital stay were observed, these findings require cautious interpretation because they were less robust and largely derived from observational evidence. Further high-quality randomized controlled trials are warranted to confirm these potential benefits.