1
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Kim EY, Park SE, Hong TH. What we should consider to facilitate recovery of the hematological profile in all patients after pancreaticoduodenectomy: the role of preoperative intravenous iron treatment. BMC Surg 2023; 23:308. [PMID: 37828447 PMCID: PMC10571369 DOI: 10.1186/s12893-023-02217-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/04/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND In pancreaticoduodenectomy (PD), the duodenum and upper jejunum responsible for iron absorption are removed, which can lead to massive hemorrhage during surgery and cause iron deficiency anemia after PD. The aim of this study was to evaluate overall changes in hematologic profiles of patients who underwent pancreaticoduodenectomy. Effect of preoperative intravenous iron treatment on recovery of anemia after surgery was also investigated. METHODS From March 2021 to December 2021, patients who underwent curative PD at our institution due to periampullary lesions were enrolled. They were divided into two groups according to whether or not iron was administered before surgery. In the IV iron group, all patients had been routinely administered with 1000 mg of ferric carboxymaltose intravenously once about 3-7 days before the operation day. Contrarily, patients in the control group did not receive intravenous iron before PD. Changes in hematological profile were measured preoperatively and at 5, 14, and 30 days postoperatively. Clinical results of the two groups were compared and analyzed. Additionally, a subgroup analysis was performed for selected non-anemic patients who had preoperative hemoglobin level of 12.0 g/dl or higher to compare changes in hematologic profiles between the two groups. RESULTS Thirty patients of the IV iron group and 34 patients of the control group were analyzed. Although no difference was observed in postoperative complications or mortality, hemoglobin and iron levels were recovered significantly faster at two weeks postoperatively in the IV iron group than in the control group. Iron levels were significantly higher in the IV iron group throughout the postoperative period. In subgroup analysis conducted for non-anemic patients, hemoglobin levels were recovered significantly faster and maintained higher in the IV iron group throughout the postoperative period, although baseline levels of hemoglobin were similar between the two groups. In addition, the length of intensive care unit stay was significantly shorter in the IV iron group than in the control group. CONCLUSIONS Preoperative intravenous iron treatment might be effective in facilitating recovery of hematologic profiles of patients during the recovery period after PD regardless of the presence of preoperative anemia, thus preventing postoperative iron deficiency anemia.
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Affiliation(s)
- Eun Young Kim
- Division of Trauma and Surgical Critical Care, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung Eun Park
- Division of Hepato-biliary and Pancreas Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Tae Ho Hong
- Division of Hepato-biliary and Pancreas Surgery, Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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2
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Di Minno G, Mannucci PM, Ironside JW, Perno CF, Gürtler L, Aledort L. Convalescent plasma for administration of passive antibodies against viral agents. Haematologica 2020; 105:2710-2715. [PMID: 33256373 PMCID: PMC7716269 DOI: 10.3324/haematol.2020.267427] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Giovanni Di Minno
- Dipartimento di Medicina Clinica e Chirurgia, Centro Hub per le Emocoagulopatie, Napoli, Italy.
| | - Pier Mannuccio Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy
| | - James W Ironside
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | | | - Lutz Gürtler
- Max von Pettenkofer Institute, Ludwig Maximilians University of Munich, Munich, Germany
| | - Louis Aledort
- Mary Weinfeld Professor of Clinical Research in Hemophilia at the Icahn School of Medicine at Mount Sinai, New York City, NY, USA
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3
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Kulkarni R, Tiraki D, Wani D, Mishra AC, Arankalle VA. Risk of transfusion-associated dengue: screening of blood donors from Pune, western India. Transfusion 2018; 59:458-462. [PMID: 30727040 DOI: 10.1111/trf.15007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 08/31/2018] [Accepted: 09/10/2018] [Indexed: 01/27/2023]
Abstract
BACKGROUND Dengue, a mosquito-borne viral disease, is endemic in >125 countries worldwide. The threat of blood-borne transmission of dengue virus (DENV) has been documented. STUDY DESIGN AND METHODS This study was conducted to assess the potential magnitude of transfusion-associated dengue, by determination of DENV seromarkers in blood donations from Pune, India, during two dengue seasons (2016 and 2017). These included DENV nonstructural protein 1 (NS1), anti-DENV immunoglobulin (Ig) M, anti-DENV IgG (enzyme-linked immunosorbent assay), and DENV RNA (reverse transcription-polymerase chain reaction). RESULTS NS1 (IgM) reactivity was 1 of 209, 0.48% (11/209, 5.3%) in 2016 and 2 of 311, 0.64% (20/311, 6.4%) in 2017. Of the 34 NS1/IgM reactives, 1 NS1-reactive donor and 10 IgM-reactive donors exhibited evidence of secondary infection. DENV RNA was not detected in any of the 34 NS1/IgM reactives. Among the NS1/IgM negatives, anti-DENV IgG reactivity was high in 2016 (75%) and further increased in 2017 (87%, p = 0.002). CONCLUSION Although RNA negative, detection of 34 NS1/IgM-reactive donations, of which 11 had evidence of secondary infection, suggests the need for further evaluation on the basis of potential risk to recipients of either dengue transmission or increased risk of secondary infection. These would include multicenter studies followed by cost-benefit analyses.
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Affiliation(s)
- Ruta Kulkarni
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed To Be University), Pune, India
| | - Divya Tiraki
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed To Be University), Pune, India
| | - Dileep Wani
- Department of Immunohaematology and Blood Transfusion, Bharati Medical College and Research Center, Bharati Vidyapeeth (Deemed To Be University), Pune, India
| | - Akhilesh C Mishra
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed To Be University), Pune, India
| | - Vidya A Arankalle
- Department of Communicable Diseases, Interactive Research School for Health Affairs, Bharati Vidyapeeth (Deemed To Be University), Pune, India
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4
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The current and future role of plasma-derived clotting factor concentrate in the treatment of haemophilia A. Transfus Apher Sci 2018; 57:502-506. [DOI: 10.1016/j.transci.2018.07.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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5
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Nakayasu M, Hirano M, Muto M, Kobayashi S, Kariwa H, Yoshii K. Development of a serodiagnostic IgM-ELISA for tick-borne encephalitis virus using subviral particles with strep-tag. Ticks Tick Borne Dis 2018; 9:1391-1394. [PMID: 29960872 DOI: 10.1016/j.ttbdis.2018.06.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 06/13/2018] [Accepted: 06/22/2018] [Indexed: 10/28/2022]
Abstract
Tick-borne encephalitis virus (TBEV) is a zoonotic agent causing severe encephalitis in humans. IgM antibody detection is useful for the serological diagnosis of TBEV infection, because IgM has high specificity for each flavivirus and indicates a recent infection. Commercial IgM-ELISA kits are somewhat expensive and difficulties in their sensitivity have been suggested due to their format and formalin-inactivated antigens. Therefore, the development of an inexpensive IgM-ELISA with high specificity and sensitivity is needed. In this study, a μ-capture ELISA was developed to detect TBEV-specific IgM antibodies using subviral particles (SPs) with strep-tag (strep-SP-IgM-ELISA). The results of our strep-SP-IgM-ELISA were highly correlated with diagnoses made by the neutralization test (sensitivity: 94.1%), and our strep-SP-IgM-ELISA could detect anti-TBEV IgM antibodies in patients who could not be diagnosed with the neutralization test. Besides, 51 of 52 positive samples by a commercial IgM-ELISA were also diagnosed as positive by our strep-SP-IgM-ELISA (98.1%), and our strep-SP-IgM-ELISA could detect anti-TBEV IgM antibodies in all samples that were inconclusive based on the commercial IgM-ELISA. Our strep-SP-IgM-ELISA will be useful for diagnoses in TBE-endemic areas.
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Affiliation(s)
- Miki Nakayasu
- Laboratory of Public Health, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818, Japan
| | - Minato Hirano
- Laboratory of Public Health, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818, Japan
| | - Memi Muto
- Laboratory of Public Health, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818, Japan
| | - Shintaro Kobayashi
- Laboratory of Public Health, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818, Japan
| | - Hiroaki Kariwa
- Laboratory of Public Health, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818, Japan
| | - Kentaro Yoshii
- Laboratory of Public Health, Faculty of Veterinary Medicine, Hokkaido University, Sapporo, Hokkaido 060-0818, Japan.
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6
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Froessler B, Rueger AM, Connolly MP. Assessing the costs and benefits of perioperative iron deficiency anemia management with ferric carboxymaltose in Germany. Risk Manag Healthc Policy 2018; 11:77-82. [PMID: 29731670 PMCID: PMC5923254 DOI: 10.2147/rmhp.s157379] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Perioperative administration of ferric carboxymaltose (FCM) was previously shown to reduce both the need for transfusions and the hospital length of stay in patients with preoperative iron deficiency anemia (IDA). In this study, we estimated the economic consequences of perioperative administration using FCM vs usual care in patients with IDA from the perspective of a German hospital using decision-analytic modeling. Materials and methods The model was populated with clinical inputs (transfusion rates, blood units transfused, hospital length of stay) from a previously reported randomized trial comparing FCM vs usual care for managing IDA patients undergoing elective abdominal surgery. We applied a hospital perspective to all costs, excluding surgery-related costs in both treatment arms. One-way sensitivity analyses were undertaken to evaluate key drivers of cost analysis. Results The average costs per case treated using FCM compared to usual care were €2,461 and €3,246, respectively, for resource expenses paid by hospital per case. This would suggest potential savings achieved with preoperative intravenous iron treatment per patient of €786 per case. A sensitivity analysis varying the key input parameters indicated the cost analysis is most sensitive to changes in the length of stay and the cost of hospitalization per day. Conclusion Perioperative administration of FCM results in cost savings to hospitals based on reduced blood transfusions and length of stay following elective abdominal surgery.
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Affiliation(s)
- Bernd Froessler
- Department of Anesthesia, Lyell McEwin Hospital, Elizabeth Vale, SA, Australia.,Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Alexandra M Rueger
- Vifor Pharma, Munich, Germany.,Charité Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Kardiologie Campus Virchow-Klinikum, Berlin, Germany
| | - Mark P Connolly
- Unit of PharmacoEpidemiology and PharmacoEconomics, Department of Pharmacy, University of Groningen, Groningen, the Netherlands.,Global Market Access Solutions Sàrl, St-Prex, Switzerland
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7
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Zaidi NA. Transfusion-Related Infections. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00221-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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8
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Franchini M, Mannucci PM. The safety of pharmacologic options for the treatment of persons with hemophilia. Expert Opin Drug Saf 2016; 15:1391-400. [DOI: 10.1080/14740338.2016.1208747] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Massimo Franchini
- Department of Transfusion Medicine and Hematology, Carlo Poma Hospital, Mantova, Italy
| | - Pier Mannuccio Mannucci
- Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Fondazione IRCCS Ca’ Granda-Ospedale Maggiore Policlinico and University of Milan, Milan, Italy
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9
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Inagaki E, Sakai M, Hirano M, Muto M, Kobayashi S, Kariwa H, Yoshii K. Development of a serodiagnostic multi-species ELISA against tick-borne encephalitis virus using subviral particles. Ticks Tick Borne Dis 2016; 7:723-729. [DOI: 10.1016/j.ttbdis.2016.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/22/2016] [Accepted: 03/01/2016] [Indexed: 11/29/2022]
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10
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Di Minno G, Perno CF, Tiede A, Navarro D, Canaro M, Güertler L, Ironside JW. Current concepts in the prevention of pathogen transmission via blood/plasma-derived products for bleeding disorders. Blood Rev 2016; 30:35-48. [PMID: 26381318 PMCID: PMC7115716 DOI: 10.1016/j.blre.2015.07.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/11/2015] [Accepted: 07/13/2015] [Indexed: 02/06/2023]
Abstract
The pathogen safety of blood/plasma-derived products has historically been a subject of significant concern to the medical community. Measures such as donor selection and blood screening have contributed to increase the safety of these products, but pathogen transmission does still occur. Reasons for this include lack of sensitivity/specificity of current screening methods, lack of reliable screening tests for some pathogens (e.g. prions) and the fact that many potentially harmful infectious agents are not routinely screened for. Methods for the purification/inactivation of blood/plasma-derived products have been developed in order to further reduce the residual risk, but low concentrations of pathogens do not necessarily imply a low level of risk for the patient and so the overall challenge of minimising risk remains. This review aims to discuss the variable level of pathogenic risk and describes the current screening methods used to prevent/detect the presence of pathogens in blood/plasma-derived products.
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Affiliation(s)
- Giovanni Di Minno
- Dipartimento di Medicina Clinica e Chirurgia, Regional Reference Centre for Coagulation Disorders, Federico II University, Via S. Pansini 5, 80131 Naples, Italy.
| | - Carlo Federico Perno
- Department of Experimental Medicine and Surgery, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy
| | - Andreas Tiede
- Department of Hematology, Hemostasis, Oncology and Stem Cell Transplantation, Hannover Medical School, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany
| | - David Navarro
- Department of Microbiology, Microbiology Service, Hospital Clínico Universitario, School of Medicine, University of Valencia, Av Blasco Ibáñez 17, 46010 Valencia, Spain
| | - Mariana Canaro
- Department of Hemostasis and Thrombosis, Son Espases University Hospital, Carretera de Valdemossa, 79, 07120 Palma de Mallorca, Spain
| | - Lutz Güertler
- Max von Pettenkofer Institute for Hygiene and Medical Microbiology, University of München, Pettenkofer Str 9A, 80336 Munich, Germany
| | - James W Ironside
- National Creutzfeldt-Jakob Disease Research and Surveillance Unit, School of Clinical Sciences, University of Edinburgh, Western General Hospital, Edinburgh EH4 2XU, UK
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11
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Abdullah S, Karunamoorthi K. Malaria and blood transfusion: major issues of blood safety in malaria-endemic countries and strategies for mitigating the risk of Plasmodium parasites. Parasitol Res 2015; 115:35-47. [PMID: 26531301 DOI: 10.1007/s00436-015-4808-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/23/2015] [Indexed: 12/22/2022]
Abstract
Malaria inflicts humankind over centuries, and it remains as a major threat to both clinical medicine and public health worldwide. Though hemotherapy is a life-sustaining modality, it continues to be a possible source of disease transmission. Hence, hemovigilance is a matter of grave concern in the malaria-prone third-world countries. In order to pursue an effective research on hemovigilance, a comprehensive search has been conducted by using the premier academic-scientific databases, WHO documents, and English-language search engines. One hundred two appropriate articles were chosen for data extraction, with a particular reference to emerging pathogens transmitted through blood transfusion, specifically malaria. Blood donation screening is done through microscopic examination and immunological assays to improve the safety of blood products by detection major blood-borne pathogens, viz., HIV, HBV, HCV, syphilis, and malarial parasites. Transfusion therapy significantly dwindles the preventable morbidity and mortality attributed to various illnesses and diseases, particularly AIDS, tuberculosis, and malaria. Examination of thick and thin blood smears are performed to detect positivity and to identify the Plasmodium species, respectively. However, all of these existing diagnostic tools have their own limitations in terms of sensitivity, specificity, cost-effectiveness, and lack of resources and skilled personnel. Globally, despite the mandate need of screening blood and its components according to the blood-establishment protocols, it is seldom practiced in the low-income/poverty-stricken settings. In addition, each and every single phase of transfusion chain carries sizable inherent risks from donors to recipients. Interestingly, opportunities also lie ahead to enhance the safety of blood-supply chain and patients. It can be achieved through sustainable blood-management strategies like (1) appropriate usage of precise diagnostic tools/techniques, (2) promoting hemovigilance system, and (3) adopting novel processes of inactivation technology. Furthermore, selection of the zero-risk donors could pave the way to build a transmissible malaria-free world in the near future.
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Affiliation(s)
- Saleh Abdullah
- Department of Laboratory Medicine, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia
| | - Kaliyaperumal Karunamoorthi
- Unit of Tropical Diseases, Department of Environmental Health, Faculty of Public Health and Tropical Medicine, Jazan University, Jazan, Kingdom of Saudi Arabia.
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12
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Abstract
With advances in care, increasing numbers of people with hemophilia (PWH) achieve near-normal life expectancies and present with typical age-related cardiovascular conditions. Evidence-based guidelines for medical or surgical management of cardiovascular conditions in individuals with hemophilia are limited. Published recommendations exist for the management of some common cardiovascular conditions (eg, ischemic heart disease, atrial fibrillation), but identifying optimal strategies for anticoagulant or antithrombotic therapy constitutes the primary challenge of managing nonoperative cardiovascular disease (CVD) in PWH. In general, as long as factor concentrates or other hemostatic therapies maintain adequate hemostasis, the recommended medical and surgical management of CVD in PWH parallels that in individuals without hemophilia. The presence of factor inhibitors complicates hemophilia management. Published outcomes of CVD treatment in PWH are similar to those in the general population. Specific knowledge about factor replacement, factor inhibitors, and disease-specific treatment distinguishes the cardiovascular care of PWH from similar care of individuals without this rare bleeding disorder. Furthermore, a multidisciplinary approach incorporating a hematologist with an onsite coagulation laboratory, ideally associated with a hemophilia treatment center, is integral to the management of CVD in PWH.
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13
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Principles of treatment and update of recommendations for the management of haemophilia and congenital bleeding disorders in Italy. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 12:575-98. [PMID: 25350962 DOI: 10.2450/2014.0223-14] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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14
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Berntorp E, Dolan G, Hermans C, Laffan M, Santagostino E, Tiede A. Pharmacokinetics, phenotype and product choice in haemophilia B: how to strike a balance? Haemophilia 2015; 20 Suppl 7:1-11. [PMID: 25370925 DOI: 10.1111/hae.12556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2014] [Indexed: 12/24/2022]
Abstract
At the 7th Annual Congress of the European Association for Haemophilia and Allied Disorders (EAHAD) held in Brussels, Belgium, in February 2014, Pfizer sponsored a satellite symposium entitled: "Pharmacokinetics, phenotype and product choice in haemophilia B: How to strike a balance?" Co-chaired by Cedric Hermans (Cliniques Universitaires Saint Luc, Brussels, Belgium) and Mike Laffan (Imperial College, London, UK), the symposium provided an opportunity to debate whether pharmacokinetic (PK) parameters are good surrogates for clinical efficacy for haemophilia B in clinical practice, consider the perceptions and evidence of disease severity, and examine how these considerations can inform approaches to balancing the potential risks and benefits of the currently available treatment options for haemophilia B. PK parameters are routinely measured in clinical practice and are a requirement of regulatory bodies to demonstrate the clinical efficacy of products; however, the relationship between measured PK parameters and clinical efficacy is yet to be determined, an issue that was debated by Gerry Dolan (University Hospital, Queen's Medical Centre, Nottingham, UK) and Erik Berntorp (Lund University, Malmö Centre for Thrombosis and Haemostasis, Malmö, Sweden). Elena Santagostino (Universita degli Studi di Milano, Milano, Italy) reviewed how differing perceptions on the severity of haemophilia B compared with haemophilia A may have an impact on clinical decision-making. Finally, Andreas Tiede (Hannover Medical School, Hannover, Germany), examined the considerations for balancing the potential risks and benefits of the currently available treatment options for haemophilia B. Although the pathophysiology of haemophilia B has been widely studied and is largely understood, continued investigation and discussion around the optimal management course and appropriate therapeutic choice is warranted.
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Affiliation(s)
- E Berntorp
- Malmö Centre for Thrombosis and Haemostasis, Lund University, Malmö, Sweden
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15
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Astermark J, Dolan G, Hilberg T, Jiménez-Yuste V, Laffan M, Lassila R, Lobet S, Martinoli C, Perno CF. Managing haemophilia for life: 4th Haemophilia Global Summit. Haemophilia 2015; 20 Suppl 5:1-20. [PMID: 24924596 DOI: 10.1111/hae.12468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The 4th Haemophilia Global Summit was held in Potsdam, Germany, in September 2013 and brought together an international faculty of haemophilia experts and delegates from multidisciplinary backgrounds. The programme was designed by an independent Scientific Steering Committee of haemophilia experts and explored global perspectives in haemophilia care, discussing practical approaches to the optimal management of haemophilia now and in the future. The topics outlined in this supplement were selected by the Scientific Steering Committee for their relevance and potential to influence haemophilia care globally. In this supplement from the meeting, Jan Astermark reviews current understanding of risk factors for the development of inhibitory antibodies and discusses whether this risk can be modulated and minimized. Factors key to the improvement of joint health in people with haemophilia are explored, with Carlo Martinoli and Víctor Jiménez-Yuste discussing the utility of ultrasound for the early detection of haemophilic arthropathy. Other aspects of care necessary for the prevention and management of joint disease in people with haemophilia are outlined by Thomas Hilberg and Sébastian Lobet, who highlight the therapeutic benefits of physiotherapy and sports therapy. Riitta Lassila and Carlo-Federico Perno describe current knowledge surrounding the risk of transmission of infectious agents via clotting factor concentrates. Finally, different types of extended half-life technology are evaluated by Mike Laffan, with a focus on the practicalities and challenges associated with these products.
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Affiliation(s)
- J Astermark
- Department of Hematology and Vascular Disorders, Skåne University Hospital, Malmö/Lund, Sweden
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16
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Blasi A, Beltran J, Pereira A, Puig L. [The cryoprecipitate: that old unknown]. ACTA ACUST UNITED AC 2015; 62:204-12. [PMID: 25561426 DOI: 10.1016/j.redar.2014.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 11/12/2014] [Accepted: 11/17/2014] [Indexed: 11/27/2022]
Abstract
Cryoprecipitate is a plasma derivative rich in fibrinogen and other procoagulant factors. It has been successfully used for decades in the treatment of the coagulopathy of trauma patients, cardiovascular surgery, liver failure and disseminated intravascular coagulation. Although cryoprecipitate is routinely used in many western countries, most of the Spanish regional blood banks stopped its production in the late 1990's. Moreover, in recent years there is a movement to replace cryoprecipitate with manufactured fibrinogen concentrate. As a consequence, many of the younger anaesthesiologists did not have any direct experience with cryoprecipitate. This article aims to describe the characteristics of cryoprecipitate since it is a different product from manufactured fibrinogen concentrate, with its own specific indications that deserve to be further studied in clinical trials.
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Affiliation(s)
- A Blasi
- Servicio de Anestesiología y Reanimación, Hospital Clínic. IDIBAPS, Barcelona, España.
| | - J Beltran
- Servicio de Anestesiología y Reanimación, Hospital Clínic. IDIBAPS, Barcelona, España
| | - A Pereira
- Servicio de Hemoterapia y Hemostasia, Hospital Clínic, Barcelona, España
| | - L Puig
- Banco de Sangre y Tejidos de Cataluña, Barcelona, España
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17
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Di Minno G, Canaro M, Ironside JW, Navarro D, Perno CF, Tiede A, Gürtler L. Pathogen safety of long-term treatments for bleeding disorders: still relevant to current practice. Haematologica 2014; 98:1495-8. [PMID: 24091928 DOI: 10.3324/haematol.2013.084145] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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18
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Abstract
The development of a new recombinant factor VIII was designed and implemented to answer a number of unmet needs of patients affected by hemophilia A. Turoctocog alfa is bioengineered in a specific Chinese hamster ovary clone to present translational and posttranslational characteristics (sulphation, glycosylation) biosimilar to natural circulating forms of FVIII, with the aim to devoid any minimal change which may impact immunogenicity and antigenicity of recombinant protein. Both producer cell line and media are maintained free of any animal or human plasma derivative. Downstream processes of purification are performed by five steps (immunoaffinity chromatography, ion-exchange chromatography, virus inactivation by means of solvent-detergent treatment and nanofiltration, and to end with gel filtration), to provide the best possible margin of safety from known and unknown infectious agents. Large clinical trials seem to confirm the expectations placed in Turoctocog alfa in terms of high quality and safety of recombinant FVIII toward the goal of overcoming actual and future challenges of hemophilia therapy.
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Affiliation(s)
- Massimo Morfini
- Previous Director of Haemophilia Center, University Hospital of Florence, Via dello Statuto n.1-50129 Florence, Italy
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19
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Chidumayo NN, Yoshii K, Saasa N, Sakai M, Kariwa H. Development of a tick-borne encephalitis serodiagnostic ELISA using recombinant Fc-antigen fusion proteins. Diagn Microbiol Infect Dis 2014; 78:373-8. [DOI: 10.1016/j.diagmicrobio.2013.12.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/16/2013] [Accepted: 12/26/2013] [Indexed: 11/26/2022]
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Elliott BM, Aledort LM. Restoring hemostasis: fibrinogen concentrate versus cryoprecipitate. Expert Rev Hematol 2013; 6:277-86. [PMID: 23782082 DOI: 10.1586/ehm.13.22] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Fibrinogen plays a key role in the coagulation process, and therefore maintaining adequate quantities of fibrinogen is an essential step in achieving satisfactory hemostasis in patients with acquired hypofibrinogenemia. Potential options for treating acquired hypofibrinogenemia in patients with uncontrolled bleeding include the use of cryoprecipitate or fibrinogen replacement therapy. This review provides a brief overview of the hemostatic process and the methods for assessing coagulopathy and discusses the efficacy and safety of cryoprecipitate and fibrinogen concentrate in restoring fibrinogen levels, achieving hemostasis and reducing transfusion requirements in different patient populations requiring rapid hemostasis. Other issues relevant to the clinical use of these agents in restoring hemostasis, including variations in product composition, preparation time and cost, are also examined.
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Affiliation(s)
- Brian M Elliott
- Division of Hematology/Oncology, Mount Sinai Medical Center, One Gustave L Levy Place, Box 1079, NY 10029, USA.
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21
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Delwart E. Human parvovirus 4 in the blood supply and transmission by pooled plasma-derived clotting factors: does it matter? Transfusion 2012; 52:1398-403. [PMID: 22780892 DOI: 10.1111/j.1537-2995.2012.03721.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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22
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Orlova NA, Kovnir SV, Vorobiev II, Gabibov A. Coagulation Factor IX for Hemophilia B Therapy. Acta Naturae 2012; 4:62-73. [PMID: 22872812 PMCID: PMC3408704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Factor IX is a zymogen enzyme of the blood coagulation cascade. Inherited absence or deficit of the IX functional factor causes bleeding disorder hemophilia B, which requires constant protein replacement therapy. Reviewed herein are the current state in the manufacturing of FIX, improved variants of the recombinant protein for therapy, transgenic organisms for obtaining FIX, and the advances in the gene therapy of hemophilia B.
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Affiliation(s)
- N. A. Orlova
- Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian
Academy of Sciences
- Hematology Research Centre, Ministry of Healthcare and Social Development
of the Russian Federation
| | - S. V. Kovnir
- Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian
Academy of Sciences
- Hematology Research Centre, Ministry of Healthcare and Social Development
of the Russian Federation
| | - I. I. Vorobiev
- Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian
Academy of Sciences
- Hematology Research Centre, Ministry of Healthcare and Social Development
of the Russian Federation
| | - A.G. Gabibov
- Shemyakin and Ovchinnikov Institute of Bioorganic Chemistry, Russian
Academy of Sciences
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23
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Pierro A, Gaibani P, Manisera C, Dirani G, Rossini G, Cavrini F, Ghinelli F, Ghinelli P, Finarelli AC, Mattivi A, Macini PL, Castellani G, Landini MP, Sambri V. Seroprevalence of West Nile Virus–Specific Antibodies in a Cohort of Blood Donors in Northeastern Italy. Vector Borne Zoonotic Dis 2011; 11:1605-7. [DOI: 10.1089/vbz.2011.0616] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Anna Pierro
- Operative Unit of Clinical Microbiology, Regional Reference Centre for Microbiological Emergencies (CRREM), S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Paolo Gaibani
- Operative Unit of Clinical Microbiology, Regional Reference Centre for Microbiological Emergencies (CRREM), S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Claudia Manisera
- Operative Unit of Clinical Microbiology, Regional Reference Centre for Microbiological Emergencies (CRREM), S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giorgio Dirani
- Operative Unit of Clinical Microbiology, Regional Reference Centre for Microbiological Emergencies (CRREM), S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Giada Rossini
- Operative Unit of Clinical Microbiology, Regional Reference Centre for Microbiological Emergencies (CRREM), S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Francesca Cavrini
- Operative Unit of Clinical Microbiology, Regional Reference Centre for Microbiological Emergencies (CRREM), S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | | | | | | | | | | | - Maria Paola Landini
- Operative Unit of Clinical Microbiology, Regional Reference Centre for Microbiological Emergencies (CRREM), S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Vittorio Sambri
- Operative Unit of Clinical Microbiology, Regional Reference Centre for Microbiological Emergencies (CRREM), S. Orsola-Malpighi University Hospital, Bologna, Italy
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Abstract
Haemophilia A and B are X-linked bleeding disorders due to the inherited deficiency of factor VIII or factor IX, respectively. Of the approximately 1 per 5000-10000 male births affected by haemophilia, 80% are deficient in factor VIII and 20% are deficient in factor IX. Haemophilia is characterized by spontaneous and provoked joint, muscle, gastrointestinal and CNS bleeding leading to major morbidity and even mortality if left untreated or under-treated. The evolution of haemophilia management has been marked by tragedy and triumph over recent decades. Clotting factors and replacement strategies continue to evolve for patients without inhibitors. For patients with an inhibitor, factor replacement for acute bleeding episodes and immune tolerance, immune modulation and extracorporeal methods for inhibitor reduction are the cornerstone of care. In addition, adjuvant therapies such as desmopressin, antifibrinolytics and topical agents also contribute to improved outcomes for patients with and without inhibitors. The future direction of haemophilia care is promising with new longer-acting clotting factors and genetic therapies, including gene transfer and premature termination codon suppressors. With these current and future treatment modalities, the morbidity and mortality rates in patients with haemophilia certainly will continue to improve.
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Affiliation(s)
- Trisha Wong
- Puget Sound Blood Center, Seattle, Washington, USA
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25
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Ozier Y, Hunt BJ. Against: Fibrinogen concentrate for management of bleeding: against indiscriminate use. J Thromb Haemost 2011; 9:6-8. [PMID: 21210948 DOI: 10.1111/j.1538-7836.2010.04083.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Y Ozier
- Service d'Anesthesie-Reanimation Chirurgicale, Université Paris Descartes, Hopital Cochin, Paris, France.
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27
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Erickson RA, Presley SM, Allen LJ, Long KR, Cox SB. A stage-structured, Aedes albopictus population model. Ecol Modell 2010. [DOI: 10.1016/j.ecolmodel.2010.01.018] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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28
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Zaidi N. Transfusion-related infections. Infect Dis (Lond) 2010. [DOI: 10.1016/b978-0-323-04579-7.00238-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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29
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Evolution of recombinant factor VIII safety: KOGENATE and Kogenate FS/Bayer. Int J Hematol 2009; 90:446-454. [PMID: 19882376 DOI: 10.1007/s12185-009-0435-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2009] [Revised: 09/22/2009] [Accepted: 10/07/2009] [Indexed: 12/28/2022]
Abstract
The use of factor VIII (FVIII) concentrates in the treatment of hemophilia A has raised important safety issues, historically of pathogen transmission and increasingly of inhibitor development to FVIII treatment. While manufacturing processes of current recombinant FVIII products have been shaped entirely around preventing pathogen transmission, the same modifications that afford a greater margin of safety could affect immunogenicity of the product, consequences of which could only be seen through long-term clinical experience. This review summarizes pathogen safety and inhibitor reports from clinical trials, post-marketing surveillance studies, and study reports on KOGENATE and its successor, Kogenate FS/Bayer. Although KOGENATE and Kogenate FS/Bayer are nearly identical products, subtle manufacturing improvements to address the need for greater margins of safety from a pathogen transmission perspective have also led to a potentially improved immunogenicity profile (15% in previously untreated/minimally treated patients with severe hemophilia A for Kogenate FS/Bayer). Notably, there has been no occurrence of pathogen contamination, and minimal de novo inhibitor formation in previously treated patients throughout the use of both products. Overall, KOGENATE and Kogenate FS/Bayer have a long history of safety in a variety of clinical settings, including treatment of bleeding, surgical management, and prophylaxis therapy.
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Recombinant Thrombin: Safety and Immunogenicity in Burn Wound Excision and Grafting. J Burn Care Res 2009; 30:371-9. [DOI: 10.1097/bcr.0b013e3181a28979] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Grillberger L, Kreil TR, Nasr S, Reiter M. Emerging trends in plasma-free manufacturing of recombinant protein therapeutics expressed in mammalian cells. Biotechnol J 2009; 4:186-201. [PMID: 19226552 PMCID: PMC2699044 DOI: 10.1002/biot.200800241] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Mammalian cells are the expression system of choice for therapeutic proteins, especially those requiring complex post‐translational modifications. Traditionally, these cells are grown in medium supplemented with serum and other animal‐ or human‐derived components to support viability and productivity. Such proteins are also typically added as excipients and stabilizers in the final drug formulation. However, the transmission of hepatitis B in the 1970s and of hepatitis C and HIV in the 1980s through plasma‐derived factor VIII concentrates had catastrophic consequences for hemophilia patients. Thus, due to regulatory concerns about the inherent potential for transmission of infectious agents as well as the heterogeneity and lack of reliability of the serum supply, a trend has emerged to eliminate the use of plasma‐derived additives in the production and formulation of recombinant protein therapeutics. This practice began with products used in the treatment of hemophilia and is progressively expanding throughout the entire industry. The plasma‐free method of producing recombinant therapeutics is accomplished by the use of both cell culture media and final product formulations that do not contain animal‐ or human‐derived additives. A number of recombinant therapeutic proteins for the treatment of several different diseases have been produced by plasma‐free processes, with the objective of improving safety by eliminating blood‐borne pathogens or by reducing immunogenicity. This review describes the factors that drove the development of plasma‐free protein therapeutics and provides examples of advances in manufacturing that have made possible the removal of human and animal‐derived products from all steps of recombinant protein production.
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Wilder-Smith A, Chen LH, Massad E, Wilson ME. Threat of dengue to blood safety in dengue-endemic countries. Emerg Infect Dis 2009; 15:8-11. [PMID: 19116042 PMCID: PMC2660677 DOI: 10.3201/eid1501.071097] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Modeling the risk for transmission of this disease is quantified by blood transfusions. Dengue, the most common arbovirus infection globally, is transmitted by mosquito vectors. Healthcare-related transmission, including transmission by blood products, has been documented, although the frequency of these occurrences is unknown. Dengue is endemic to Singapore, a city-state in Asia. Using mathematical modeling, we estimated the risk for dengue-infected blood transfusions in Singapore in 2005 to be 1.625–6/10,000 blood transfusions, assuming a ratio of asymptomatic to symptomatic infections of 2:1 to 10:1. However, the level of viremia required to cause clinical dengue cases is person-dependent and unknown. Further studies are needed to establish the magnitude of the threat that dengue poses to blood safety in countries where it is endemic. It will then be possible after this information is obtained to assess whether screening is feasible and to identify approaches that are most cost-effective on the basis of characteristics of local populations and seasonality of dengue.
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Abstract
Summary. Plasma‐derived factor VIII (FVIII) and von Willebrand Factor (VWF)/FVIII concentrates have been successfully used to treat haemophilia since the late 1960s. These products are derived from pools of plasma donations that may contain viral contaminants – including hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) – and may therefore present a transmission risk to recipients. To ensure the safety of Haemate® P/Humate‐P®, a plasma‐derived VWF/FVIII concentrate, donors of plasma are carefully selected and all donations are screened for viral antigens (HBV), virus‐specific antibodies (HIV‐1/2, HCV) and genomic material [hepatitis A virus, HBV, HCV, HIV‐1 and high titres of human parvovirus B19 (B19V)]. As a quality control measure, plasma pools for fractionation are only released for further processing when non‐reactivity has been demonstrated in serological and genome amplification assays. The manufacturing process for plasma‐derived products, especially the fundamental procedure of pasteurization, is effective in inactivating and/or removing a wide variety of viruses that may potentially be present despite the screening process. This has been demonstrated in virus validation studies using a range of different viruses. New emerging infectious agents, including prions, which potentially pose a threat to recipients of plasma derivatives, are also the subject of safety evaluations. The multiple precautionary measures that are inherent in the overall production process of Haemate P/Humate‐P have resulted in an excellent safety record, documented during 25 years of clinical use, and will help to maintain the high safety margin in the future.
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Affiliation(s)
- A Gröner
- CSL Behring GmbH, Marburg, Germany.
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34
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Abstract
BACKGROUND The goal of the coagulation pathway is the conversion of fibrinogen to fibrin and formation of an insoluble clot. Although relatively rare, congenital fibrinogen disorders are interesting and pose several challenges that can serve as paradigms for many diseases. An impressive body of knowledge has accumulated recently, particularly thanks to international collaborative clinical and genetic studies allowing the molecular characterization of these disorders. However, apart from the possibility of developing safer fibrinogen concentrates and the availability of prenatal diagnosis, the basic therapeutic approach has changed little. OBJECTIVE We need to better understand the clinical phenotype of patients in order to administer fibrinogen preparations or other treatments more appropriately. METHODS We discuss current therapeutic options and others that could be available in the near future. RESULTS/CONCLUSION Patients with congenital fibrinogen deficiencies require better predictive tests for clinical complications and more efficient and available fibrinogen concentrates. Global hemostasis tests in combination with routine assays could help to individually tailor therapeutic protocols.
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Affiliation(s)
- Philippe de Moerloose
- University Hospital, Division of Angiology and Haemostasis, 1211 Geneva 14, Switzerland.
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35
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Consensus opinion for the selection and use of therapeutic products for the treatment of haemophilia in Spain. Blood Coagul Fibrinolysis 2008; 19:333-40. [DOI: 10.1097/mbc.0b013e328300c814] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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36
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Warfarin reversal with prothrombin complex concentrate confers better antifibrinolytic activity compared with recombinant activated factor VII. Blood Coagul Fibrinolysis 2008; 19:106-8. [DOI: 10.1097/mbc.0b013e3282f185c9] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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37
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38
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39
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Abstract
Clotting factor transfusions are vital for people with diseases such as haemophilia. In the 1970s and 1980s, transfusions with pooled plasma led to a devastatingly high number of recipients becoming infected with blood-borne pathogens such as HIV and hepatitis C. This epidemic triggered the development of virus-free factor concentrates through a combination of improved donor selection and screening, effective virucidal technologies, and recombinant protein expression biotechnology. There is now a wide range of recombinant factor concentrates, and an impressive safety record with respect to pathogen transmission. However, remaining therapeutic challenges include the potential threat of transmission of prions and other pathogens, the formation of inhibitory alloantibodies, and the international disparity that exists in product availability due to differences in licensure status as well as prohibitively high costs. In the future, it is likely that bioengineered recombinant proteins that have been modified to enhance pharmacokinetic properties or reduce immunogenicity, or both, will be used increasingly in clinical practice.
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Affiliation(s)
- Nigel S Key
- University of North Carolina School of Medicine and Harold R Roberts Comprehensive Hemophilia Diagnostic and Treatment Center, Chapel Hill, NC, USA.
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40
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Abstract
The appropriate development of hemostasis encompasses a delicate equilibrium between anti- and prothrombotic forces developing during three distinct phases (primary hemostasis, coagulation and fibrinolysis) that are closely linked to each other and precisely regulated to close vessel wounds, promote vascular healing and maintain vessel patency. Imbalance in each of these systems produces either hemorrhagic or thrombotic disorders. Inherited bleeding disorders, caused by quantitative or qualitative alterations of either platelets or plasma proteins involved in blood coagulation and fibrinolysis, may lead to serious and lifelong bleeding conditions, the severity of which is inversely associated with the degree of the underlying defect. Rapid and reliable identification of these pathologies is worthy of focus to allow the adoption of appropriate substitutive or supportive antihemorrhagic therapies. Evaluation of the hemorrhage-prone patient requires careful recording of the medical history, attention to pertinent physical findings and the discretionary use of laboratory resources. Owing to the low diagnostic efficiency of clinical history and examination, an appropriate and reliable laboratory approach, encompassing first- and second-line testing, is essential to screen, diagnose and monitor patients with bleeding diatheses. As both the analytical sensitivity and responsiveness of traditional coagulation assays to different abnormalities differ widely, each laboratory should establish individual guidelines based on field experience and on reagent and instrument characteristics. Emerging evidence indicates that the implementation of global coagulation tests, such as the thrombin generation assay and clot waveform analysis, would provide additional information for clinical decision-making for patients with inherited bleeding disorders.
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Affiliation(s)
- Giuseppe Lippi
- Sezione di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Verona, Italy.
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41
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Meeks SL, Josephson CD. Should hemophilia treaters switch to albumin-free recombinant factor VIII concentrates. Curr Opin Hematol 2006; 13:457-61. [PMID: 17053459 DOI: 10.1097/01.moh.0000245686.01591.f0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW To discuss the advantages and disadvantages of the albumin-free recombinant factor VIII concentrates in the treatment of hemophilia A. RECENT FINDINGS The third-generation recombinant factor VIII product Advate has been found to be safe and effective in treating bleeding associated with hemophilia A. SUMMARY Multiple issues must be considered when selecting a factor VIII concentrate for patients with hemophilia A including efficacy, availability, risk of transmission of infectious agents, risk of inhibitor development and cost. Third-generation recombinant factor VIII concentrates have been shown to be safe and effective. A theoretical improvement in risk of infectious agent transmission has been achieved by production of the products without human or animal plasma proteins. Controversy exists, however, with regard to a higher risk of inhibitor development with recombinant products. The higher cost of Advate can also potentially play a role in product choice. Overall every patient and their family must be presented with the advantages and disadvantages of all factor VIII concentrates, and be allowed to make an informed decision about which product to use for treatment.
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Affiliation(s)
- Shannon L Meeks
- Aflac Cancer Center and Blood Disorders Service, Emory University/Children's Healthcare of Atlanta, USA.
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42
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De Sousa PA, Galea G, Turner M. The road to providing human embryo stem cells for therapeutic use: the UK experience. Reproduction 2006; 132:681-9. [PMID: 17071769 DOI: 10.1530/rep.1.01080] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Harnessing the unparalleled properties of human embryo stem cells (hESCs) for the therapeutic treatment of disease and injury will require a convergence of scientific developments with regulatory standards. In the case of the latter, it is especially critical that standards for clinically assisted reproduction be harmonized with those governing human cell and tissue transplantation, most notably with respect to procurement, donation, testing, processing, preservation, storage and distribution of cells. In the UK, existing infrastructure to address these considerations is undergoing extensive reorganization to keep pace with evolving European Union standards. The present best paradigm for defining standards for the therapeutic use of embryo-derived stem cells is experience with adult haematopoietic stem cells (HSC). However, compared with adult-derived stem cell, the origin of embryo-derived stem cells from limiting quantities of tissue and their absolute dependence on in vitro culture to realise their therapeutic potential, makes optimization of their isolation and cultivation of even greater importance. Most notable is the requirement to create animal cell product-free culture environments to reduce the risk of cross-specific disease transmission. In the present paper, we review present and emerging standards in the isolation and banking of human embryo-derived stem cells for therapeutic use in the UK and international progress in the development of defined culture systems for this purpose.
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Affiliation(s)
- Paul A De Sousa
- Centre for Regenerative Medicine, College of Medicine & Veterinary Medicine, University of Edinburgh, Chancellor's Building, Rm GU. 531, 49 Little France Crescent, Edinburgh, EH16 4SB, UK.
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Abstract
Hemophilia is a congenital disorder due to the deficiency of the activity of factor VIII (classical hemophilia A) or IX (Christmas disease or hemophilia B). Bleeding is common and may result in long-term complications or even death. Bleeding may be treated or prevented by infusion of factor concentrates however these drugs are not without risk. Clinicians often feel ill prepared to provide accurate and impartial information regarding these drugs. This review will provide the reader with an historical yet up to date perspective on blood safety as it relates to the choice of concentrates to treat hemophilia.
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Affiliation(s)
- Leonard A Valentino
- RUSH Hemophilia and Thrombophilia Center, Department of Pediatrics, Rush University Medical Center, Chicago, Illinois 60612, USA.
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Chapman WC, Lockstadt H, Singla N, Kafie FE, Lawson JH. Phase 2, randomized, double-blind, placebo-controlled, multicenter clinical evaluation of recombinant human thrombin in multiple surgical indications. J Thromb Haemost 2006; 4:2083-5. [PMID: 16961621 DOI: 10.1111/j.1538-7836.2006.02067.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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45
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Ellis DI, Goodacre R. Metabolic fingerprinting in disease diagnosis: biomedical applications of infrared and Raman spectroscopy. Analyst 2006; 131:875-85. [PMID: 17028718 DOI: 10.1039/b602376m] [Citation(s) in RCA: 331] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The ability to diagnose the early onset of disease, rapidly, non-invasively and unequivocally has multiple benefits. These include the early intervention of therapeutic strategies leading to a reduction in morbidity and mortality, and the releasing of economic resources within overburdened health care systems. Some of the routine clinical tests currently in use are known to be unsuitable or unreliable. In addition, these often rely on single disease markers which are inappropriate when multiple factors are involved. Many diseases are a result of metabolic disorders, therefore it is logical to measure metabolism directly. One of the strategies employed by the emergent science of metabolomics is metabolic fingerprinting; which involves rapid, high-throughput global analysis to discriminate between samples of different biological status or origin. This review focuses on a selective number of recent studies where metabolic fingerprinting has been forwarded as a potential tool for disease diagnosis using infrared and Raman spectroscopies.
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Affiliation(s)
- David I Ellis
- School of Chemistry, University of Manchester, Faraday Building, PO Box 88, Sackville Street, Manchester, UK M60 1QD.
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