Annals of blood最新文献

{"title":"Applying principles of patient blood management during COVID-19 pandemic: a literature review","authors":"Aditi Khandelwal, H. VanderMeulen, Bryan Tordon, K. Pavenski","doi":"10.21037/aob-22-1","DOIUrl":"https://doi.org/10.21037/aob-22-1","url":null,"abstract":"As of 15 December 2021, coronavirus disease 2019 (COVID-19) affected approximately 271 million and killed 5.3 million people globally. COVID-19 pandemic had a tremendous impact on world healthcare systems and blood supply. While principles of patient blood management (PBM) may have been previously implemented in many jurisdictions, their widespread adoption has become imperative during the pandemic. This review will discuss the impact of the COVID-19 pandemic on the Canadian blood supply and how the principles of PBM could be applied during a pandemic or other disruptions to healthcare delivery or blood supply. We described the local blood system and how it adapted during the pandemic. We also included a discussion of pandemic-associated local PBM challenges and solutions. We conducted a brief review of English language literature with a specific focus on the application of PBM to reduce unnecessary red blood cell (RBC) transfusions in elective major surgery, hematological malignancies, elective major gynecological surgery and obstetrics between January 2020 and April 2022. The common themes included anemia diagnosis and management, restrictive RBC transfusion strategies and reduction in blood loss. Anemia is common, is frequently caused by iron deficiency and can be treated with oral or intravenous iron. Erythropoiesis stimulating agents are effective in raising hemoglobin and may be indicated in certain perioperative settings. Evidence supports the use of restrictive RBC transfusion thresholds and single unit transfusions in most patient populations. Hemostatic therapy, such as tranexamic acid, is generally safe and effective in reducing bleeding. Diagnostic phlebotomy contributes to anemia and should be restricted to tests that are necessary and likely to change management. In conclusion, PBM interventions are generally effective and safe. Prioritization of PBM during the pandemic or a blood shortage may help sustain the blood supply and lead to improved patient outcomes.Copyright © Annals of Blood. All rights reserved.","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43457623","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Strategies to meet blood demand for transfusions during the COVID-19 pandemic: lessons learnt from a large central hospital in Malawi","authors":"Stephen Njolomole, B. M’baya, George Mandere, Evance Storey, A. Jenny, Titus Chiwindo, Festus Nyangu, D. Walker, A. Muula","doi":"10.21037/aob-21-88","DOIUrl":"https://doi.org/10.21037/aob-21-88","url":null,"abstract":"Background: The coronavirus disease-19 (COVID-19) pandemic affected blood banks globally. We sought to examine how COVID-19 affected blood supply and transfusion in our institution. Method(s): The study was conducted at the Queen Elizabeth Central Hospital (QECH) and the Malawi Blood Transfusion Service (MBTS) in Malawi. Data from April to November 2020, collected during the pandemic, were compared with data from the same time period in 2019 pre-COVID-19. Additionally, in-depth interviews with key personnel were conducted at both institutions. Statistical analysis was performed using Stata 15 and qualitative data were analyzed using Nvivo software. Result(s): There was a significant reduction in blood supplied to the QECH from 7,303 [2019] to 6,028 units [2020] (P<0.04). The highest reduction in blood supply was to the Adult Emergency & Trauma department (29%) while the lowest was in Obstetrics & Gynecology, and Pediatric departments (17% reduction each). This is despite that the transfusion services continued to conduct blood drives during the pandemic, and the hospital laboratory prioritized blood issuing for emergency indications. Conclusion(s): Blood supply has significantly reduced during COVID-19 pandemic in our centers. Developing plans for overcoming similar shortages in future pandemics is critical.Copyright © Annals of Blood. All rights reserved.","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46683819","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transfusion management during extracorporeal membrane oxygenation for extended indications: a narrative review","authors":"Stefano Tigano, Chiara Vitiello, M. D’Alesio, F. Sanfilippo, M. Astuto, A. Arcadipane, G. Martucci","doi":"10.21037/aob-21-81","DOIUrl":"https://doi.org/10.21037/aob-21-81","url":null,"abstract":"","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47785026","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 convalescent plasma: mechanisms of action and rationale for use: a narrative review","authors":"A. Al‐Riyami","doi":"10.21037/AOB-2020-CP-01","DOIUrl":"https://doi.org/10.21037/AOB-2020-CP-01","url":null,"abstract":"The use of convalescent plasma (CP) transfusions for patients with coronavirus disease 2019 (COVID-19) has gained great interest during the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. This review aims at summarizing the literature on the potential mechanisms of action of COVID-19 CP (CCP) and the rationale for use. A narrative review of the literature was conducted using PubMed, Google Scholar, and the Cochrane Database through October 2020. The rationale of CCP deployment was based on historical use in other outbreaks and pandemics and the emergent need at the time of lack of proven therapies and vaccines. There are many proposed mechanisms of action including direct neutralization and suppression of viremia, antibody-dependent cellular cytotoxicity, modification of the inflammatory response, restoration of the coagulation factors, immunomodulation of the hypercoagulable state and the potential role of ABO naturally occurring iso-agglutinins. Many donor, product, and patient factors can impact the response to CCP, such as antibody titer in the CCP product, CCP dose, frequency of administration, the severity of underlying illness, and the timing of administration from time of disease onset. Based on current evidence, CCP appears to be safe. However, it remains unknown whether it impacts the improvement of clinical symptoms, time to death, and all-cause mortality. In conclusion, the use of CCP offers quick access as an empirical therapy when specific therapies are not available or under development. Ongoing clinical trials are expected to add to the breadth of knowledge on the safety and efficacy of CCP use in patients with COVID-19.Copyright © 2021 AME Publishing Company.","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48095865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Molecular typing of blood group genes in diagnostics","authors":"L. Castilho","doi":"10.21037/AOB-20-73","DOIUrl":"https://doi.org/10.21037/AOB-20-73","url":null,"abstract":": The molecular basis associated with the expression of all blood group antigens in the 43 blood group systems recognized by the International Society of Blood Transfusion (ISBT) was established and most are due to single nucleotide variations (SNVs). This allowed the development of a plethora of DNA tests to predict blood group antigens. Molecular typing of blood group genes in diagnostics facilitates the resolution of clinical problems that cannot be addressed by hemagglutination. They are useful to determine antigen types for which there is no typing reagents; to type patients who have been recently transfused or with warm auto antibodies; for definition of blood group variants; in prenatal testing; to search for rare blood types and to increase the reliability of repositories of antigen negative red blood cells (RBCs) for transfusion. This review summarizes the employment of molecular blood group typing and its benefits in diagnostics, especially in transfusion medicine and in maternal-fetal medicine. Advances in molecular methods have enabled the implementation of blood group genotyping in clinical laboratories changing work practices and revolutionizing the way transfusion is managed. The strength of next generation sequencing (NGS) of whole genomes or exomes or by targeting the specific blood group loci combined with pretransfusion serologic testing will enhance immunohematology in daily transfusion practice.","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42490279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In silico molecular dynamics of human glycophorin A (GPA) extracellular structure","authors":"Serena Ekman, R. Flower, S. Mahler, Alison Gould, R. Barnard, C. Hyland, Martina L. Jones, A. Malde, Xuan T Bui","doi":"10.21037/AOB-20-51","DOIUrl":"https://doi.org/10.21037/AOB-20-51","url":null,"abstract":"Background: Glycophorin A (GPA) is one of two glycoproteins found on the surface of human red blood cells (RBCs) that constitute the MNS blood group system. The structure of GPA’s extracellular domain is unknown despite previous attempts using X-ray crystallography and NMR spectroscopy. As a result, there is a knowledge gap regarding antigen presentation. This hinders the production of monoclonal antibodies (mAbs) against MNS antigens. Methods: In silico modelling techniques including homology modelling and ab initio predictions were implemented to develop a proposed structure for the monomeric form of the GPA extracellular domain. Developed structures were then subjected to molecular dynamics (MD) simulations. Results: The results obtained indicated that the monomeric extracellular domain of GPA is most likely intrinsically disordered, with the exception of a β -hairpin-like structure spanning the exon 3–4 junction. Further analysis showed this β -hairpin-like structure was not observed when starting from an extended or cyclical peptide structure within the time-scale used in the MD simulation study, suggesting that linear or cyclical peptide fragments of this region are unsuitable representations for the purposes of antigen presentation. Lastly, of the MNS antigens produced by single amino acid variations found in the exon 3–4 junction, only the ERIK antigen (p.Gly78Arg; MNS37) was found to alter the β -hairpin-like structure. Conclusions: The monomer of the extracellular domain of GPA has a high level of disorder, with the exception of the antigenic exon 3–4 junction, which adopts a β -hairpin-like structure. Our work suggests that linear peptides and expression of the monomeric form of GPA might be of limited use for immunisation or screening processes used in antibody identification. Further understanding of the antigenic determinants of GPA will require a more sophisticated combination of laboratory and computational approaches, as well as consideration of possible structural changes as a result of dimerisation.","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46474761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance evaluation of two supplemental confirmatory assays of hepatitis C virus antibody","authors":"Li Zhang, Yi Zha, Li Shi, Y. Qiu","doi":"10.21037/AOB-20-67","DOIUrl":"https://doi.org/10.21037/AOB-20-67","url":null,"abstract":"Background: The overall relative change in Hepatitis C virus (HCV) reporting incidences was 1.16 in China recently, which exhibited increasing trend in most provinces. Screening tests for HCV antibodies are prone to generate higher false positivity in low-risk populations. The aim of this study was to compare the performance of two HCV supplemental confirmatory assays CWT (Wantai Biological Pharmaceutical Co., Ltd, Beijing, China) and RIBA HCV 3.0 SIA (RIBA 3.0). Methods: We selected 530 reactive specimens identified by two rounds of anti-HCV enzyme-linked immunosorbent assays (EIA) to carry out CWT and RIBA 3.0 supplemental tests simultaneously. Then the parallel testing results were evaluated as positive, indeterminate and negative, and made comparative analysis. Results: There were 182 and 160 confirmed positive samples for CWT and RIBA 3.0 respectively, of which 128 (24.2%) cases were common positive. the positive rate of CWT (34.3%) was significantly higher than RIBA 3.0 (30.2%) (P<0.01). And the common negative and indeterminate specimens were 156 (29.4%) and 53 (10%). The remaining 193 (36.4%) specimens had inconsistent results. The 182 CWT positive specimens included 35 indeterminate specimens (22%, 35/164) and 18 negative specimens (8.7%, 18/206) of RIBA 3.0. The diagnostic results of RIBA 3.0 and CWT supplementary assays were generally consistent (kappa =0.445, P<0.01). Conclusions: This study suggested that RIBA 3.0 and CWT each had its own genetic sequences of target peptides on HCV confirmatory tests and the latter might be more applicable for China’s current HCV epidemic strains. The number of positive cases confirmed by CWT is higher than that of RIBA 3.0, which corroborates this.","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49246568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"FDA guidance on bacterial contamination risk control strategies to enhance the safety and availability of platelets: advantages and limitations","authors":"M. R. Jacobs","doi":"10.21037/AOB-21-10","DOIUrl":"https://doi.org/10.21037/AOB-21-10","url":null,"abstract":"Bacterial contamination of platelets was first addressed by primary culture, introduced in US in 2004, which ameliorated but did not solve the problem. Guidance to further decrease bacterial contamination were published by the US Food and Drug Administration in September 2019; recommended implementation is by October 2021. These include three single-step strategies: (I) culture at ≥36 h of ≥16 mL (≥8 mL aerobic, ≥8 mL anaerobic) per split apheresis unit or whole-blood derived pool; 5 day outdate; (II) culture at ≥48 h of ≥16 mL (≥8 mL aerobic, ≥8 mL anaerobic) per split apheresis unit; 7 day outdate; (III) pathogen reduction of apheresis units performed within 24 h of collection (5-day outdate). Several two-step strategies are available: First step has two options: (I) culture ≥36 h of ≥16 mL as in single-step option 1 (5 day outdate); (II) culture at ≥24 h after collection of ≥16 mL (≥8 mL aerobic, ≥8 mL anaerobic) per apheresis collection or split unit, or whole-blood derived pool (3 day outdate). The second step has three options to extend these outdates: (I) secondary culture of each unit of ≥8 mL (aerobic) on ≥ day 3 (extends outdate to 5 days); (II) secondary culture of each unit of ≥16 mL as in step 1 on ≥ day 4 (extends outdate to 7 days); (III) rapid testing of each unit within 24 hours of transfusion on ≥ day 3 (extends outdate to 7 days). This review addresses advantages and limitations of these strategies based on evidence of their efficacy.","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44027346","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of immune thrombocytopenia in pregnancy","authors":"Jacqueline N. Poston, T. Gernsheimer","doi":"10.21037/AOB-20-58","DOIUrl":"https://doi.org/10.21037/AOB-20-58","url":null,"abstract":"Immune thrombocytopenia (ITP) presents unique challenges in the peripartum setting. The diagnosis of ITP is similar to the nonpregnant patient except pregnancy related causes of thrombocytopenia must be considered. Management of ITP will change over the course of pregnancy and closer monitoring is critical as delivery approaches when the recommended platelet goal increases from 20×10–30×10/L to above 50×10/L for a vaginal delivery. If an epidural is required, the platelet count should be above 70×10/L. The mode of delivery is based on obstetrical indications. First line therapies are glucocorticoids or intravenous immunoglobulin (IVIG). Many second line therapies may be safe in pregnancy. Contraindicated therapies include syk inhibitors, vinca alkaloids, mycophenolate mofetil, cyclophosphamide and danazol. Limited case series report safe administration of the thrombopoietin receptor agonists (TPORAs) without adverse fetal outcomes. While the majority of neonates are unaffected, neonatal platelet counts can decline in the first days after delivery and may require therapy. Maternal treatment and platelet count do not appear to predict the risk of neonatal thrombocytopenia; the strongest predictor is a previous sibling’s history. ITP is not a contraindication for pregnancy; women with a history of ITP should not be discouraged from becoming pregnant as their ITP can be safely managed with close monitoring and multidisciplinary coordination with obstetrics and pediatrics.","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48396776","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous immunoglobulins (IVIg) in childhood immune thrombocytopenia: towards personalized medicine—a narrative review","authors":"D. Schmidt, K. M. Heitink-Polle, M. Bruin, M. Haas","doi":"10.21037/AOB-20-59","DOIUrl":"https://doi.org/10.21037/AOB-20-59","url":null,"abstract":": In childhood immune thrombocytopenia (ITP), the morbidity is significant due to the risk of bleeding and a reduced health-related quality of life (HRQoL). Current management guidelines indicate that treatment is considered for children with moderate to severe bleeding, or a reduced HRQoL. Intravenous immunoglobulin (IVIg) treatment has been introduced in childhood ITP in 1981. IVIg treatment speeds up the remission of thrombocytopenia in newly diagnosed ITP and reduces bleeding symptoms, but this has the disadvantage of side effects and costs. Some data indicated that IVIg may modulate the late disease outcomes of ITP, but our recent randomized controlled trial (RCT) showed that IVIg does not affect the development of chronic ITP. Overall, 60% of children with newly diagnosed ITP show a sustained response to IVIg. Such a sustained response after IVIg treatment is strongly associated with long-term remission from ITP. Recent molecular and clinical data show that treatment responders could be identified before IVIg is administered. The same molecular and clinical characteristics that identify treatment responders are otherwise associated with a transient, self-limiting ITP disease course, suggesting the identification of a distinct subgroup of ITP patients. Thus, the development of multivariate clinical and molecular prediction scores could allow to individualize treatment decisions, i.e., target IVIg to those who benefit the most. These prediction scores may also be used to design studies aimed at identifying children who benefit from adjunctive or alternative treatments, such as thrombopoietin receptor agonists (TPO-Ra).","PeriodicalId":72211,"journal":{"name":"Annals of blood","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48750813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}