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Talarico AM. Acute chest syndrome in sickle cell disease. Nursing 2024; 54:38-41. [PMID: 39051957 DOI: 10.1097/nsg.0000000000000004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024]
Abstract
ABSTRACT Sickle cell disease (SCD) is an autosomal recessive disorder altering the shape of red blood cells, causing harmful obstructions in blood vessels, therefore altering normal blood flow. SCD can escalate quickly into acute chest syndrome (ACS), a life-threatening complication that requires immediate care. This article discusses the pathophysiology, assessment, diagnosis, and treatment of ACS, as well as nursing care and patient education.
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Affiliation(s)
- Annamarie M Talarico
- Annamarie Talarico is an RN at University Hospitals Cleveland Medical Center Seidman Cancer Center in Cleveland, Ohio. The author acknowledges the support of graduate professors Marcy Caplin, PhD, RN, CNE and Tina Saunders, PhD, RN, CNE, GCNS-BC
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de Winter DP, Lopriore E, Hulzebos CV, Lukens MV, Klinkspoor JHH, van Bohemen M, den Besten G, de Vooght KMK, Vrancken SLAG, Trompenaars AMP, Hoffmann-Haringsma A, Péquériaux NCVN, Andriessen P, Gijzen K, van Hillegersberg JLAMJ, Zant JC, van Rossem MC, van Gammeren AJA, Weerkamp F, Counsilman CE, Knol FRR, Schiering IAMI, Dubbink-Verheij GH, Verweij EJTJ, de Haas M. Use and Waste of Reconstituted Whole Blood Exchange Transfusions: An 11-year National Observational Study. J Pediatr 2024; 275:114225. [PMID: 39095011 DOI: 10.1016/j.jpeds.2024.114225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Revised: 07/18/2024] [Accepted: 07/29/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES To identify indications for exchange transfusions, assess the use and waste of exchange transfusion products (ie, reconstituted whole blood exchange transfusions), and determine nationwide distribution and prevalence of these transfusions in the Netherlands. STUDY DESIGN All 9 neonatal intensive care units and 15 non-neonatal intensive care unit hospitals participated in this retrospective, observational, cohort study. We retrieved data on the indications for and use of all exchange transfusion products ordered by participating centers over an 11-year period. RESULTS A total of 574 patients for whom 1265 products were ordered were included for analyses. Severe ABO (32.6%) and non-ABO (25.2%) immune hemolysis and subsequent hyperbilirubinemia were the most frequent indications. Rare indications were severe leukocytosis in Bordetella pertussis (2.1%) and severe anemia (1.5%). Approximately one-half of all ordered products remained unused. In 278 of 574 neonates (48.4%), ≥1 products were not used, of which 229 (82.7%) were due to the resolving of severe hyperbilirubinemia with further intensification of phototherapy. The overall prevalence of neonates who received an exchange transfusion was 14.6:100 000 liveborn neonates. CONCLUSIONS A considerable proportion of products remained unused, and annually a limited number of patients are treated with an exchange transfusion in the Netherlands, highlighting the rarity of the procedure in the Netherlands.
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Affiliation(s)
- Derek P de Winter
- Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands; Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands; Department of Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, the Netherlands.
| | - Enrico Lopriore
- Division of Neonatology, Department of Pediatrics, Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Christian V Hulzebos
- Division of Neonatology, Department of Pediatrics, Beatrix Children's Hospital, University Medical Center Groningen, Groningen, the Netherlands
| | - Michaël V Lukens
- Laboratory for Blood Transfusion, Department of Laboratory Medicine, University Medical Center Groningen, Groningen, the Netherlands
| | - J H Harriët Klinkspoor
- Central Diagnostic Laboratory, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Michaela van Bohemen
- Department of Clinical Chemistry, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Gijs den Besten
- Department of Clinical Chemistry, Isala, Zwolle, the Netherlands
| | | | - Sabine L A G Vrancken
- Department of Neonatology, Radboud UMC, Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Amanda M P Trompenaars
- Division of Neonatology, Department of Pediatrics, MosaKids Children's Hospital, Maastricht University Medical Center, Maastricht, the Netherlands
| | | | - N C V Nathalie Péquériaux
- Department of Clinical Chemistry and Hematology, Jeroen Bosch Hospital, 's-Hertogenbosch, the Netherlands
| | - Peter Andriessen
- Department of Neonatology, Máxima Medical Center, Veldhoven, the Netherlands
| | - Karlijn Gijzen
- Department of Clinical Chemistry and Hematology, Meander Medical Center, Amersfoort, the Netherlands
| | | | - Janneke C Zant
- Department of Clinical Chemistry, Northwest Clinics, Alkmaar and Den Helder, the Netherlands
| | | | | | - Floor Weerkamp
- Department of Clinical Chemistry, Maasstadziekenhuis, Rotterdam, the Netherlands
| | | | - F R Rachel Knol
- Department of Pediatrics, Medisch Centrum Leeuwarden, Leeuwarden, the Netherlands
| | | | | | - E J T Joanne Verweij
- Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Masja de Haas
- Department of Immunohematology Diagnostic Services, Sanquin Diagnostic Services, Amsterdam, the Netherlands; Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands
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3
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Ma J, Yin Q, Ye F, Ba Z, Geng H. The efficacy of erythrocyte apheresis for treatment of secondary erythrocytosis: An observational study. Medicine (Baltimore) 2024; 103:e38815. [PMID: 39029086 DOI: 10.1097/md.0000000000038815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
To evaluate the efficacy of erythrocyte apheresis on the treatment of secondary erythrocytosis. Patients with secondary erythrocytosis who had visited the Department of Hematology at the Qinghai University Affiliated Hospital between January 2021 and May 2022 were enrolled. Based on the treatment method used, the patients were divided into erythrocytapheresis group and bloodletting group. In total, 50 patients were treated using a hemocyte separator and 36 patients were treated with bloodletting. The outcomes of 2 groups were compared. Compared with the bloodletting group, the clinical symptoms improved, blood routine indicators such as RBC, Hb, and HCT significantly reduced, and the progression rate was lower in the erythrocytapheresis group. Erythrocytic apheresis is effective and safe for the treatment of secondary erythrocytosis.
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Affiliation(s)
- Jie Ma
- Department of Hematology, Qinghai University Affiliated Hospital, Xining, China
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Szczerbinska A, Kasztelan-Szczerbinska B, Rycyk-Bojarzynska A, Kocki J, Cichoz-Lach H. Hemochromatosis-How Not to Overlook and Properly Manage "Iron People"-A Review. J Clin Med 2024; 13:3660. [PMID: 38999226 PMCID: PMC11242024 DOI: 10.3390/jcm13133660] [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: 05/16/2024] [Revised: 06/20/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Hemochromatosis (HC) is the main genetic disorder of iron overload and is regarded as metal-related human toxicosis. HC may result from HFE and rare non-HFE gene mutations, causing hepcidin deficiency or, sporadically, hepcidin resistance. This review focuses on HFE-related HC. The illness presents a strong biochemical penetrance, but its prevalence is low. Unfortunately, the majority of patients with HC remain undiagnosed at their disease-curable stage. The main aim of HC management is to prevent iron overload in its early phase and remove excess iron from the body by phlebotomy in its late stage. Raising global awareness of HC among health staff, teaching them how not to overlook early HC manifestations, and paying attention to careful patient monitoring remain critical management strategies for preventing treatment delays, upgrading its efficacy, and improving patient prognosis.
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Affiliation(s)
- Agnieszka Szczerbinska
- Faculty of Medicine, Medical University of Warsaw, 61 Zwirki i Wigury Street, 02-091 Warsaw, Poland
| | - Beata Kasztelan-Szczerbinska
- Department of Gastroenterology with Endoscopy Unit, Medical University of Lublin, 8 Jaczewski Street, 20-954 Lublin, Poland
| | - Anna Rycyk-Bojarzynska
- Department of Gastroenterology with Endoscopy Unit, Medical University of Lublin, 8 Jaczewski Street, 20-954 Lublin, Poland
| | - Janusz Kocki
- Department of Clinical Genetics, Medical University of Lublin, 11 Radziwillowska Street, 20-080 Lublin, Poland
| | - Halina Cichoz-Lach
- Department of Gastroenterology with Endoscopy Unit, Medical University of Lublin, 8 Jaczewski Street, 20-954 Lublin, Poland
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Kearney L, Bosnick R, Phillips H, Ghio A, Cullen D, Sweat L, Zheng Y. Optimization of single-needle red cell exchange in patients with sickle cell disease. J Clin Apher 2024; 39:e22118. [PMID: 38682445 DOI: 10.1002/jca.22118] [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: 02/12/2024] [Revised: 03/25/2024] [Accepted: 04/14/2024] [Indexed: 05/01/2024]
Abstract
The hypercoagulable state associated with sickle cell disease (SCD) can be challenging for apheresis procedures. Among 62 single-needle red cell exchanges (SN-RCEs) performed over a 15-month period, 4 patients experienced 6 hemolytic events with a discolored plasma layer, elevated plasma/RBC interface in the centrifuge, and accompanying alarms of "Cells were detected in plasma line from centrifuge" or "AIM system detected RBC at top of connector." The hemolysis originated from the apheresis instrument because samples from the apheresis belt but not the patients' peripheral blood were positive for hemolysis. Further analysis showed the alarms occurred more often in SN-RCEs (20.4%) than double-needle RCEs (2.7%), and the hemolysis was probably secondary to clumping. To optimize SN-RCE, we increased the anticoagulant dosage by changing Inlet/AC ratio from 13 to 8 and lowered the inlet rate to the level comparable to double-needle RCE. The adjustments were well-tolerated with no more hemolysis.
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Affiliation(s)
- Lilora Kearney
- Department of Nursing, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Regina Bosnick
- Department of Nursing, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Haley Phillips
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Amanda Ghio
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Dierdre Cullen
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Lori Sweat
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
| | - Yan Zheng
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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Ramírez-Guerrero G, de Cal M, Lorenzin A, Vigolo D, Toscano AI, Araya-Rojas M, Zanella M, Ronco C. Sorbent functionalization with vancomycin enhances bacteria killing in extracorporeal hemoadsorption. Artif Organs 2024; 48:543-549. [PMID: 38156403 DOI: 10.1111/aor.14704] [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: 08/12/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND The level of bacteremia in patients with sepsis and septic shock is a predictor of complications and mortality, regardless of the type of bacteria. Devices for bacteria, endotoxin and cytokines removal by adsorption have been recently developed. Thus, extracorporeal blood purification therapies have been proposed as adjunctive therapy in sepsis in combination with drugs. Some potentially useful drugs, however, are precluded due to their organ or metabolic toxicity. The present study represents a preliminary report on the in vitro effect of a sorbent device (minimodule with HA380 beads, Jafron medical, Zhuhai, China) in which the particles have been functionalized with vancomycin on the surface. The impact of the surface-modified beads on circulating bacteria (Staphylococcus aureus) has been tested in a simulated in vitro circulation. METHODS In vitro experiments were carried out with 800 mL of blood enriched with S. aureus species. Blood was circulated in the vancomycin-functionalized and non-functionalized mini-module cartridges in hemoadsorption setup (300 mL each) and the bactericidal effect was assessed. Also, 200 mL of blood was used as a control. RESULTS A significant increase in the time to positivity of blood cultures was observed after 60 min and also after 120 min of therapy with the mini-module functionalized with vancomycin as opposed to the non-functionalized cartridge. CONCLUSIONS These results suggest a possible way of treating sepsis by using drug- or antibiotic-functionalized cartridges without worrying about pharmacological toxicity. The prolongation of the time to bacterial culture positivity to S. aureus after a passage through a column packed with beads functionalized with vancomycin represents a proof of concept.
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Affiliation(s)
- Gonzalo Ramírez-Guerrero
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
- Nephrology and Dialysis Unit, Carlos Van Buren Hospital, Valparaíso, Chile
- Department of Medicine, Universidad de Valparaíso, Valparaíso, Chile
| | - Massimo de Cal
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Anna Lorenzin
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Dario Vigolo
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
| | - Anna Italia Toscano
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
| | | | - Monica Zanella
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
- Department of Nephrology, Dialysis and Kidney Transplantation, San Bortolo Hospital, Vicenza, Italy
| | - Claudio Ronco
- International Renal Research Institute of Vicenza (IRRIV Foundation), Vicenza, Italy
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Zikou X, Vaia D, Vasiliki P, Panagiotis C, Stavros A. Use of Therapeutic Apheresis methods in ICU. Transfus Apher Sci 2024; 63:103853. [PMID: 38049358 DOI: 10.1016/j.transci.2023.103853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023]
Abstract
Apheresis is a modern medical approach in which plasma or cellular components are separated from the whole blood. Apheresis can be either diagnostic or therapeutic. Diagnostic apheresis is typically applied in hematology and cancer research. Therapeutic Apheresis (TA) includes a broad spectrum of extracorporeal treatments applied in various medical specialties, including Intensive Care Unit (ICU). Considering the complexity of the pathophysiologic characteristics of various clinical entities and in particular sepsis, apheresis methods are becoming increasingly applicable. Therapeutic Plasma Exchange (TPE) is the most common used method in ICU. It is considered as first line therapy for Thrombotic Thrombocytopenic Purpura (TTP) and Guillain Barre Syndrome, while the current data for sepsis are scarce. Over the last decades, technologic evolution has led to increasing application of new and more selective methods based on adsorptive techniques. In this review we will describe the current data of characteristics of different techniques, safety and clinical impact of apheresis methods used in ICUs.
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Valentini CG, Pellegrino C, Ceglie S, Arena V, Di Landro F, Chiusolo P, Teofili L. Red Blood Cell Exchange as a Valid Therapeutic Approach for Pregnancy Management in Sickle Cell Disease: Three Explicative Cases and Systematic Review of Literature. J Clin Med 2023; 12:7123. [PMID: 38002735 PMCID: PMC10672461 DOI: 10.3390/jcm12227123] [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: 10/11/2023] [Revised: 11/08/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Pregnancy in women with sickle cell disease (SCD) is a high-risk situation, especially during the third trimester of gestation and in the post-partum period, due to chronic hypoxia and vaso-occlusive phenomena occurring in the maternal-fetal microcirculation: as a result, unfavorable outcomes, such as intra-uterine growth restriction, prematurity or fetal loss are more frequent in SCD pregnancies. Therefore, there is a consensus on the need for a strict and multidisciplinary follow-up within specialized structures. Transfusion support remains the mainstay of treatment of SCD pregnancies, whereas more targeted modalities are still controversial: the benefit of prophylactic management, either by simple transfusions or by automated red blood cell exchange (aRBCX), is not unanimously recognized. We illustrate the cases of three SCD pregnant patients who underwent aRBCX procedures at our institution in different clinical scenarios. Moreover, we carried out a careful literature revision to investigate the management of pregnancy in SCD, with a particular focus on the viability of aRBCX. Our experience and the current literature support the use of aRBCX in pregnancy as a feasible and safe procedure, provided that specialized equipment and an experienced apheresis team is available. However, further research in this high-risk population, with appropriately powered prospective trials, is desirable to refine the indications and timing of aRBCX and to confirm the advantages of this approach on other transfusion modalities.
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Affiliation(s)
- Caterina Giovanna Valentini
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
| | - Claudio Pellegrino
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Sara Ceglie
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Vincenzo Arena
- Sezione di Patologia, Dipartimento di Scienze della Salute della Donna, del Bambino e di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, Istituto di Anatomia Patologica, Università Cattolica Del Sacro Cuore, 00168 Rome, Italy
| | - Francesca Di Landro
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Patrizia Chiusolo
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Luciana Teofili
- Dipartimento di Diagnostica per Immagini, Radioterapia Oncologica ed Ematologia, Fondazione Policlinico Universitario “A. Gemelli” IRCCS, 00168 Rome, Italy
- Sezione di Ematologia, Dipartimento di Scienze Radiologiche ed Ematologiche, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Iuliani O, Passeri C, Inghilleri G, Di Bartolomeo E, Abbruzzese L, Bianco I, Foddai ML, Natale GA, De Fusco G, D'Onofrio M, Fadda MG, Dominijanni A, Savignano C, Ostuni A. Survey on the usage of therapeutic erythrocytapheresis in transfusion services in Italy for the treatment of polycythemia vera, secondary erythrocytosis and hemochromatosis. Transfus Apher Sci 2023; 62:103752. [PMID: 37355441 DOI: 10.1016/j.transci.2023.103752] [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: 12/02/2022] [Revised: 06/10/2023] [Accepted: 06/14/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Erythrocytapheresis, an apheresis treatment which selectively removes red blood cells, is an alternative to therapeutic phlebotomy, over which it has several advantages. Actually there is a high degree of variability in the use of this treatment. This prompted SIdEM (Italian Society of Hemapheresis and Cell Manipulation) to conduct a survey on the use of erythrocytapheresis in the Italian Transfusion Services. The purpose is to monitor this activity in the treatment of Polycythemia Vera (pv), secondary erythrocytosis and hemochromatosis. MATERIALS AND METHODS A data collection file was sent to the SIdEM regional delegates who, in turn, involved the Transfusion Centers in the areas they cover. The data collected were processed on a Microsoft Excel spreadsheet. RESULTS 75 centers from 14 Italian regions responded to the Survey: 36 centers (48 %) use erythrocytapheresis (35 centers perform therapeutic apheresis and 1 center only donor apheresis), 39 centers (52 %) do not (15 centers perform therapeutic apheresis, 18 centers only donor apheresis and 6 centers do not perform either therapeutic apheresis or donor apheresis). Although most centers have a substantially uniform attitude concerning the indications for which erythrocytapheresis is used, the survey shows that there are still differences more evident in the treatment of secondary erythrocytosis than in the treatment of pv or hemochromatosis. CONCLUSIONS This survey has been useful to document the current Italian reality and to raise awareness about the need for improvement in optimizing and standardizing the use of a therapy with a great potential to exploit properly.
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Affiliation(s)
- O Iuliani
- UOC Immunoematologia, Medicina Trasfusionale e Ambulatori di Ematologia, Dipartimento Oncologico Ematologico, Ospedale Spirito Santo Hospital, Pescara, Italy.
| | - C Passeri
- UOC Immunoematologia, Medicina Trasfusionale e Ambulatori di Ematologia, Dipartimento Oncologico Ematologico, Ospedale Spirito Santo Hospital, Pescara, Italy
| | - G Inghilleri
- UOC Servizio di Immunoematologia e Medicina Trasfusionale, ASST Bergamo Est, Seriate, BG, Italy
| | - E Di Bartolomeo
- Transfusion Medicine Unit, Azienda USL-IRCCS Reggio Emilia, Reggio Emilia, Italy
| | - L Abbruzzese
- Servizio di Immunoematologia e Medicina Trasfusionale, Azienda Ospedaliera "Card. G. Panico", Tricase, LE, Italy
| | - I Bianco
- U.O. Medicina Trasfusionale e Biologia dei Trapianti, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - M L Foddai
- UOSD Immunotrasfusionale, IRCCS Istituto Nazionale Tumori Regina Elena, Roma, Italy
| | - G A Natale
- UOSD Immunotrasfusionale, IRCCS Istituto Nazionale Tumori Regina Elena, Roma, Italy
| | - G De Fusco
- Servizio di Immunoematologia e Medicina Trasfusionale, Azienda ULSS 3 Serenissima, Ospedale dell'Angelo - Mestre (VE), Italy
| | - M D'Onofrio
- Servizio di Immunoematologia e Medicina Trasfusionale, Ospedale "Luigi Curto", Polla, Salerno, Italy
| | - M G Fadda
- Servizio di Immunoematologia e Centro Trasfusionale, ARNAS G. Brotzu, Cagliari, Italy
| | - A Dominijanni
- Servizio di Immunoematologia e Medicina Trasfusionale Azienda Ospedaliera "Pugliese Ciaccio", Catanzaro, Italy
| | - C Savignano
- Dipartimento di Medicina Trasfusionale, Azienda Sanitaria Universitaria del Friuli Centrale, Udine, Italy
| | - A Ostuni
- Unità Operativa di Medicina Trasfusionale, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, University of Bari "Aldo Moro", Bari, Italy
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10
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Ronco C, Chawla L, Husain-Syed F, Kellum JA. Rationale for sequential extracorporeal therapy (SET) in sepsis. Crit Care 2023; 27:50. [PMID: 36750878 PMCID: PMC9904264 DOI: 10.1186/s13054-023-04310-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/07/2023] [Indexed: 02/09/2023] Open
Abstract
Sepsis and septic shock remain drivers for morbidity and mortality in critical illness. The clinical picture of patients presenting with these syndromes evolves rapidly and may be characterised by: (a) microbial host invasion, (b) establishment of an infection focus, (c) opsonisation of bacterial products (e.g. lipopolysaccharide), (d) recognition of pathogens resulting in an immune response, (e) cellular and humoral effects of circulating pathogen and pathogen products, (f) immunodysregulation and endocrine effects of cytokines, (g) endothelial and organ damage, and (h) organ crosstalk and multiple organ dysfunction. Each step may be a potential target for a specific therapeutic approach. At various stages, extracorporeal therapies may target circulating molecules for removal. In sequence, we could consider: (a) pathogen removal from the circulation with affinity binders and cartridges (specific), (b) circulating endotoxin removal by haemoperfusion with polymyxin B adsorbers (specific), (c) cytokine removal by haemoperfusion with sorbent cartridges or adsorbing membranes (non-specific), (d) extracorporeal organ support with different techniques for respiratory and cardiac support (CO2 removal or extracorporeal membrane oxygenation), and renal support (haemofiltration, haemodialysis, or ultrafiltration). The sequence of events and the use of different techniques at different points for specific targets will likely require trials with endpoints other than mortality. Instead, the primary objectives should be to achieve the desired action by using extracorporeal therapy at a specific point.
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Affiliation(s)
- Claudio Ronco
- International Renal Research Institute of Vicenza, IRRIV Foundation, Department of Nephrology, Dialysis and Transplantation, St. Bortolo Hospital, aULSS8 Berica, Via Rodolfi, 37, 36100, Vicenza, Italy.
- Department of Medicine (DIMED), University of Padua, Via Giustiniani, 2, 35128, Padua, Italy.
| | - Lakhmir Chawla
- Department of Medicine, Veterans Affairs Medical Center, 3350 La Jolla Village Dr, San Diego, CA, 92161, USA
| | - Faeq Husain-Syed
- Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Klinikstrasse 33, 35392 Giessen, Germany
- Division of Nephrology, University of Virginia School of Medicine, 1300 Jefferson Park Avenue, Charlottesville, VA, 22908, USA
| | - John A Kellum
- Center for Critical Care Nephrology, CRISMA, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, 3550 Terrace Street, Pittsburgh, PA, 15261, USA
- Spectral Medical, 135 The West Mall, Unit 2, Toronto, M9C 1C2, Canada
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Al Mozain N, Elobied Y, Al-Omran A, Aljaloud A, Omair AB, Tuwaim RB, Alkhalifah S, Altawil ES, Abraham S, Salcedo LR, Parena A, Shah F, Ayyoubi MT, Hermelin D, Al Gahtani F, Alfeky MA, El Gohary G. Comparative study between chronic automated red blood cell exchange and manual exchange transfusion in patients with sickle cell disease: A single center experience from Saudi Arabia. Asian J Transfus Sci 2023; 17:91-96. [PMID: 37188028 PMCID: PMC10180797 DOI: 10.4103/ajts.ajts_13_21] [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: 01/30/2021] [Accepted: 06/01/2021] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Red cell transfusion remains the gold standard in managing sickle cell disease (SCD) with severe complications. Offering red blood cell exchange (RBCX) either manual exchange transfusion (MET) or automated RBCX (aRBCX) can reduce the complications of chronic transfusion and maintain target Hb thresholds. This study audits the hospital experience of overseeing adult SCD patients treated with RBCX, both automated and manual, and compares the safety and efficacy. MATERIALS AND METHODS This retrospective observational study was conducted as an audit for chronic RBCX for adult patients with SCD in 2015-2019 at King Saud University Medical City, Riyadh, Saudi Arabia. RESULTS A total of 344 RBCX for 20 adult SCD patients who were enrolled in regular RBCX, (11/20) patients had regular aRBCX with a total of (157) sessions, and (9/20) patients had MET with a total of (187) sessions. The median level of HbS% post-aRBCX was significantly lower than MET (24.5.9% vs. 47.3%, P < 0.010). Patients on aRBCX had fewer sessions (5 vs. 7.5, P < 0.067) with better disease control. Although the median yearly pRBC units per patient for aRBCX was more than the double needed for MET (28.64 vs. 13.39, P < 0.010), the median ferritin level was 42 μg/L in aRBCX versus 983.7 μg/L in MET, P < 0.012. CONCLUSION Compared to MET, aRBCX was more effective in reducing HbS, with fewer hospital visits and better disease control. Although more pRBCs were transfused, the ferritin level was better controlled in the aRBCX group without increasing alloimmunization risk.
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Affiliation(s)
- Nour Al Mozain
- Department of Pathology and Laboratory Medicine, King Fiasal Specialised Hospital, Riyadh, Saudi Arabia
| | - Yasmin Elobied
- Department of Blood Bank, King Saud University, Riyadh, Saudi Arabia
| | - Amal Al-Omran
- Department of Blood Bank, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alhanouf Aljaloud
- Department of Blood Bank, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Alanoud Bin Omair
- Department of Blood Bank, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Reema Bin Tuwaim
- Department of Blood Bank, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Sara Alkhalifah
- Department of Blood Bank, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Esraa S. Altawil
- Department of Pharmacy, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Sheena Abraham
- Department of Blood Bank, King Saud University, Riyadh, Saudi Arabia
| | | | - Aljoyce Parena
- Department of Blood Bank, King Saud University, Riyadh, Saudi Arabia
| | - Farrukh Shah
- Department of Hematology, Whittington Health, London, UK
| | - M. Tayyeb Ayyoubi
- Department of Blood Bank, King Saud University, Riyadh, Saudi Arabia
| | - Daniela Hermelin
- Department of Pathology, School of Medicine, Saint Louis University, St. Louis, Missouri, United States
| | - Farjah Al Gahtani
- Oncology Centre, Section of Adult Hematology/HSCT, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Mervat Abdalhameed Alfeky
- Department of Clinical Pathology, Laboratory Hematology, Ain Shams University Hospitals, Cairo, Egypt
| | - Ghada El Gohary
- Oncology Centre, Section of Adult Hematology/HSCT, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Department of Internal Medicine/Adult Hematology, Ain Shams University Hospital, Cairo, Egypt
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12
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Weigand M, Gomez-Pastora J, Strayer J, Wu X, Choe H, Lu S, Plencner E, Landes K, Palmer A, Zborowski M, Desai P, Chalmers J. The Unique Magnetic Signature of Sickle Red Blood Cells: A Comparison Between the Red Blood Cells of Transfused and Non-Transfused Sickle Cell Disease Patients and Healthy Donors. IEEE Trans Biomed Eng 2022; 69:3582-3590. [PMID: 35544484 PMCID: PMC10460628 DOI: 10.1109/tbme.2022.3172429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Sickle cell disease (SCD) is an inherited blood disorder that affects millions of people worldwide, especially in low-resource regions of the world, where a rapid and affordable test to properly diagnose the disease would be highly valued. Magnetophoresis is a technique that could simultaneously analyze, quantify, and potentially separate the patient's sickle red blood cells (RBCs) from healthy RBCs, but the magnetic characteristics of sickle RBCs have yet to be reported. In this work, we present the single cell magnetic characterization of RBCs obtained from SCD patients. Sufficient single cells are analyzed from patient samples undergoing transfusion therapy and not yet having transfusion therapy (TP and NTP, respectively), such that means and distributions of these single RBC mobilities are created in the form of histograms which facilitated comparison to RBCs from healthy donors (HD). The magnetic characterization is obtained using a technique known as Cell Tracking Velocimetry (CTV) that quantitatively characterizes the RBC response to magnetic and gravitational fields. The magnetic properties of RBCs containing oxygenated, deoxygenated hemoglobin (Hb) and methemoglobin (oxyHb-RBCs, deoxyHb-RBCs, and metHb-RBCs) are further determined. The NTP samples reported the highest magnetic character, especially when compared to oxyHb-RBCs from HD, which implies impaired oxygen binding capabilities. Also, the oxygen-Hb equilibrium curves are obtained to estimate the magnetic character of the cells under intermediate oxygen levels. Our results confirm higher magnetic moment of SCD blood (NTP) under intermediate oxygen levels. These data demonstrate the potential feasibility of magnetophoresis to identify, quantify and separate sickle RBCs from healthy RBCs.
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13
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Cunard R, Gopal S, Kopko PM, Dang MU, Hazle KM, Sanchez AP. Comprehensive guide to managing a chronic automated red cell exchange program in sickle cell disease. J Clin Apher 2022; 37:497-506. [PMID: 36172983 DOI: 10.1002/jca.22014] [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: 05/13/2022] [Revised: 08/12/2022] [Accepted: 09/01/2022] [Indexed: 11/09/2022]
Abstract
Sickle cell disease (SCD) is associated with significant morbidity and mortality, and limits both the quality and quantity of life. Transfusion therapy, specifically automated red cell exchange (aRCE), plays a key role in management of SCD and is beneficial for certain indications in the chronic, outpatient setting. The approach to maintain a successful chronic aRCE program for SCD is multifaceted. This review will highlight important considerations including indications for aRCE, patient selection, transfusion medicine pearls, vascular access needs, complications of therapy, aRCE prescription, and therapy optimization. Moreover, the importance of a multidisciplinary approach with frequent communication between the services involved cannot be overstated. Ultimately, the underlying goal of a chronic RCE program is to improve the quality of life and longevity of patients with SCD.
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Affiliation(s)
- Robyn Cunard
- Division of Nephrology-Hypertension, Veterans Affairs San Diego Healthcare System, San Diego, California, USA.,Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Srila Gopal
- Department of Medicine, University of California San Diego, La Jolla, California, USA
| | - Patricia M Kopko
- Department of Pathology and Laboratory Medicine, University of California San Diego, La Jolla, California, USA
| | | | | | - Amber P Sanchez
- Department of Medicine, University of California San Diego, La Jolla, California, USA
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14
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Alwaheed AJ, Alqatari SG, AlKhafaji DM, Al Argan RJ, Al Sultan OA, AlSulaiman RS, AlShahrani FS, Alghamdi FA, Alkhudair AM, Alghamdi AA. Clinical outcome of pre-operative blood transfusion for sickle cell disease patients in post-operative complications. Hosp Pract (1995) 2022; 50:361-367. [PMID: 36062975 DOI: 10.1080/21548331.2022.2121574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Preoperative blood transfusion for patients with sickle cell disease is a debatable topic and it can be lifesaving. Sickle cell disease patients are at high risk for vaso-occlusive crisis due to the large concentration of sickle hemoglobin (HgbS) in their blood. Despite the current extensive research into this disease, there is still no consensus over whether blood transfusion is a preferable preoperative modality among patients undergoing elective surgical procedures. METHOD A retrospective observational study, which enrolled 204 patients with Sickle cell disease who underwent surgery at King Fahad Hospital of the University (KFHU) over the last five years. The primary objective was to determine whether there is evidence that preoperative blood transfusion for SCD patients undergoing surgical procedures will reduce postoperative complications related to SCD. RESULTS A total of 204 patients were included, of which 30% had preoperative blood transfusion. Majority of patient 44% had undergone cholecystectomy. On multivariate logistic regression analysis, patients who did not undergo blood transfusion had significantly higher risk to develop post-operative SCD complications (OR=3.07, P value= 0.002). In addition, they had significantly prolonged hospitalization (OR= 2.22, P value= 0.08). In contrast, patients who received blood transfusion had lower risk for developing post-operative SCD related complications (OR=1.87, P value= 0.29), and decrease in the duration of hospitalization by (OR=0.49, P value= 0.045). CONCLUSION Our study showed that patients who had not undergo preoperative blood transfusion had higher risk to develop postoperative complications and prolonged hospital stay compared to those who underwent blood transfusion.
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Affiliation(s)
- Abrar J Alwaheed
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Safi G Alqatari
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Dania M AlKhafaji
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Reem J Al Argan
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Osama A Al Sultan
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Reem S AlSulaiman
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Faisal S AlShahrani
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Faisal A Alghamdi
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Abdullah M Alkhudair
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
| | - Abdulrahman A Alghamdi
- Department of Internal Medicine, College of Medicine-Imam Abdulrahman Bin Faisal University, King Fahd Hospital of the University, Khobar, Eastern Province, Saudi Arabia
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15
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Wallace LR, Thibodeaux SR. Transfusion Support for Patients with Sickle Cell Disease. Transfus Apher Sci 2022; 61:103556. [DOI: 10.1016/j.transci.2022.103556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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16
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Thurn S, Kleinschmidt K, Kovacic I, Wendl C, Linker RA, Corbacioglu S, Schlachetzki F. Transcranial Doppler sonography and the effect of haematopoietic stem cell transplantation in sickle cell disease. Neurol Res Pract 2022; 4:12. [PMID: 35369878 PMCID: PMC8978343 DOI: 10.1186/s42466-022-00175-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/18/2022] [Indexed: 11/21/2022] Open
Abstract
Background Sickle cell disease (SCD) is one of the most prevalent monogenetic diseases worldwide and one of the most serious complications is stroke. Transcranial Doppler (TCD) demonstrated to be highly predictive for an imminent stroke by measuring blood flow velocities in the basal cerebral arteries. Currently, the only curative therapy for SCD is hematopoietic stem cell transplantation (HSCT). The aim of this study is to verify the correlation between blood flow velocities and stroke including the effect of HSCT.
Methods In our retrospective single-center study a total of 26 sickle cell patients (HbSS, HbSß+-thalassemia, HbSSα-thalassemia minima, HbSSα-thalassemia minor and HbSC) were analyzed between 2010 and 2016. The highest time averaged maximum mean blood flow velocity (TAMMV) measured was documented and evaluated with respect to SCD genotype and effect of HSCT. Acute and symptomatic as well as silent strokes were recorded as separate parameters.
Results In our study, ten patients had normal blood flow velocities before HSCT (six HbSS and four HbSß+-thalassemia patients) and 13 patients presented with abnormal TCD (eight HbSS, three HbSSα-thalassemia minima, one HbSSα-thalassemia minor and one HbSC). Thirteen of 26 study participants (ten HbSS and three HbSß+-thalassemia patients) received HSCT. In two patients, TAMMV in basal cerebral arteries remained “normal”, in one they remained conditional and in one TAMMV was reduced to normal. Four of 26 study participants (15.4%), including all patients with HbSS genotype, presented with a stroke, but none had “abnormal” TAMMV with TCD performed after the onset of stroke in each case. At the time we performed the TCD, the patients had already suffered the stroke. Conclusion In our study, none of the patients with stroke displayed abnormal blood flow velocities in TCD. Yet, HSCT at this stage of the disease still had a positive effect on TAMMV. Further studies are needed whether this effect converts into reduced stroke risk at all or only selected SCD patients undergoing HSCT.
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Affiliation(s)
- Sylvia Thurn
- Institute of Diagnostic Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Katharina Kleinschmidt
- Department of Paediatric Haematology, Oncology and Stem Cell Transplantation, University Medical Center Regensburg, Regensburg, Germany
| | - Irena Kovacic
- Department of Neurology, University of Regensburg, Bezirksklinikum Regensburg, Regensburg, Germany.,Department of Neurology, University Medical Center Regensburg, Regensburg, Germany
| | - Christina Wendl
- Center for Neuroradiology, Bezirksklinikum Regensburg and University Medical Center Regensburg, Regensburg, Germany
| | - Ralf A Linker
- Department of Neurology, University of Regensburg, Bezirksklinikum Regensburg, Regensburg, Germany.,Department of Neurology, University Medical Center Regensburg, Regensburg, Germany
| | - Selim Corbacioglu
- Department of Paediatric Haematology, Oncology and Stem Cell Transplantation, University Medical Center Regensburg, Regensburg, Germany
| | - Felix Schlachetzki
- Department of Neurology, University of Regensburg, Bezirksklinikum Regensburg, Regensburg, Germany. .,Department of Neurology, University Medical Center Regensburg, Regensburg, Germany.
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17
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A Multicenter Evaluation of the Seraph 100 Microbind Affinity Blood Filter for the Treatment of Severe COVID-19. Crit Care Explor 2022; 4:e0662. [PMID: 35506015 PMCID: PMC9049035 DOI: 10.1097/cce.0000000000000662] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The Seraph100 Microbind Affinity Blood Filter (Seraph 100) (ExThera Medical, Martinez, CA) is an extracorporeal therapy that can remove pathogens from blood, including severe acute respiratory syndrome coronavirus 2. The aim of this study was to evaluate safety and efficacy of Seraph 100 treatment for COVID-19. DESIGN Retrospective cohort study. SETTING Nine participating ICUs. PATIENTS COVID-19 patients treated with Seraph 100 (n = 53) and control patients matched by study site (n = 53). INTERVENTION Treatment with Seraph 100. MEASUREMENTS AND MAIN RESULTS At baseline, there were no differences between the groups in terms of sex, race/ethnicity, body mass index, and need for mechanical ventilation. However, patients in the Seraph 100 group were younger (median age, 54 yr; interquartile range [IQR], 41-65) compared with controls (median age, 64 yr; IQR, 56-69; p = 0.009). Charlson comorbidity index scores were lower in the Seraph 100 group (2; IQR, 0-3) compared with the control group (3; IQR, 2-4; p = 0.006). Acute Physiology and Chronic Health Evaluation II scores were also lower in Seraph 100 subjects (12; IQR, 9-17) compared with controls (16; IQR, 12-21; p = 0.011). The Seraph 100 group had higher vasopressor-free days with an incidence rate ratio of 1.30 on univariate analysis. This difference was not significant after adjustment. Seraph 100-treated subjects were less likely to die compared with controls (32.1% vs 64.2%; p = 0.001), a difference that remained significant after adjustment. However, no difference in mortality was observed in a post hoc analysis utilizing an external control group. In the full cohort of 86 treated patients, there were 177 total treatments, in which only three serious adverse events were recorded. CONCLUSIONS Although this study did not demonstrate consistently significant clinical benefit across all endpoints and comparisons, the findings suggest that broad spectrum, pathogen agnostic, blood purification can be safely deployed to meet new pathogen threats while awaiting targeted therapies and vaccines.
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18
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Ilonze C, Anderson M, Stubblefield A, Journeycake J, Sinha AA. Use of infusion ports in patients with sickle cell disease: Indications and complications. Pediatr Blood Cancer 2022; 69:e29445. [PMID: 34786823 DOI: 10.1002/pbc.29445] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 09/27/2021] [Accepted: 10/15/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND Peripheral venous access in patients with sickle cell disease (SCD) can become difficult over time due to frequent access and scarring. Infusion ports provide reliable central venous access. Deep venous thrombosis (DVT) and infections are complications associated with SCD and infusion ports. METHODS We performed a 17.5-year single-institution retrospective chart review (January 2000 to July 2018) with literature review regarding use of infusion ports in patients with SCD. RESULTS We identified 32 patients with infusion ports placed for a total of 63 devices (48 for chronic transfusion [CT] and 15 for poor venous access [PVA], not on CT) for a total of 99,272 catheter days. The mean age at first insertion was 8 years (range 1-20 years). Complications included malfunction, infection, thrombosis, difficult access, and pain over infusion port site. The rate of infection was 0.2 per 1000 catheter days. Thrombosis was identified in three devices (5%) in three patients (9%), with a rate of 0.03 per 1000 catheter days. There was no difference in complications by site in either the left or right subclavian vein (p = 1). The rate of premature removal was 0.36 per 1000 catheter days, which was higher among patients with infusion ports solely for PVA (0.87 per 1000 catheter days) compared with those placed for CT (0.29 per 1000 catheter days). CONCLUSION Infusion ports in patients with SCD was associated with low rates of thrombosis, infection, and malfunction, and may be considered as an alternative to frequent intravenous access, especially in patients requiring CT.
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Affiliation(s)
- Chibuzo Ilonze
- Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Jimmy Everest Section of Pediatric Hematology Oncology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michael Anderson
- Department of Epidemiology & Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Alex Stubblefield
- Department of Epidemiology & Biostatistics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA.,Department of Economics, Michigan State University, East Lansing, Michigan, USA
| | - Janna Journeycake
- Jimmy Everest Section of Pediatric Hematology Oncology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Arpan A Sinha
- Jimmy Everest Section of Pediatric Hematology Oncology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
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19
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Tannous T, Cheves TA, Sweeney JD. Red Cell Exchange as Adjunctive Therapy for Babesiosis: Is it Really Effective? Transfus Med Rev 2021; 35:16-21. [PMID: 34334285 DOI: 10.1016/j.tmrv.2021.06.004] [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: 04/04/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022]
Abstract
Human babesiosis is a parasitic disease prevalent in the Northeastern and Midwestern United States (US). Treatment with antibiotics is the standard of care but red cell exchange (RCE) has been used as an adjunctive treatment in more severe disease. Data for the efficacy of RCE in the treatment of babesiosis has been based on case reports and case series. An English language literature search was conducted for cases of babesiosis treated with RCE since 1980 and relevant laboratory and clinical outcome data were extracted. Similar data were obtained on severe cases of babesiosis referred for RCE in our hospitals in the time period 2000 to 2020. Fifty reports including forty-one individual case reports and nine case series were retrieved. There were 108 patients that underwent RCE with an overall mortality rate of 20%. Some patients had more than one RCE. The patients varied in the level of anemia and evidence of compromise of renal or pulmonary function. The pre-RCE level of parasitemia varied between 1.7% to 85% with the vast majority >10%. The post-RCE level of parasitemia varied between 1% to 10%. Since 2000, 32 patients were referred for RCE in our hospitals and RCE was performed on 23 of 32. There were more patients treated with RCE in the second decade as compared to the first decade, 19 versus 4 respectively. The overall mortality was 22% similar to the national data. Comparing the cohort treated with RCE to the 9 patients who were treated only with antibiotics, there were similar levels of parasitemia and laboratory parameters. The overall number of days needed to achieve a parasite count <1% was similar between the two cohorts and mortality for the antibiotics only cohort was 0%. More than 40 years after the first reported case of RCE in severe babesiosis it cannot be concluded that this adjunctive therapy favorably influences the clinical outcome. Since there is largely equipoise, a registry of severe patients treated with or without RCE could identify a benefit or otherwise.
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Affiliation(s)
- Toufic Tannous
- Roger Williams Medical Center, Providence, RI, USA; Boston University School of Medicine, Boston, MA, USA
| | - Tracey A Cheves
- Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Joseph D Sweeney
- Roger Williams Medical Center, Providence, RI, USA; Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, RI, USA.
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20
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Njue L, Medri C, Keller P, Diepold M, Taleghani BM, Rovó A. The rare hemoglobin variant Hb Mizuho: report of a Swiss family and literature review. Ann Hematol 2021; 100:1677-1683. [PMID: 33590291 PMCID: PMC8195896 DOI: 10.1007/s00277-021-04458-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/07/2021] [Indexed: 11/29/2022]
Abstract
Hb Mizuho is a very rare unstable hemoglobin; here, we describe the clinical history of three Swiss family members with Hb Mizuho together with a systematic review of the previously six published cases. The clinical history of the adult woman we report here is unique since this is the first Hb Mizuho presenting with Moyamoya complications and the first case reported with long-term erythrocyte exchange. The literature review showed that Hb Mizuho was mainly reported as a de novo mutation, with the exception of children descended from known cases. All published patients with this unstable hemoglobin showed severe hemolytic anemia with the exception of one; all were regularly transfused. Patients with higher HbF levels might require fewer transfusions. All patients underwent splenectomy at a median age of 4 years and had variable clinical improvement; some achieved complete resolution of transfusion dependency after splenectomy. Iron overload in Hb Mizuho patients seems to be mainly attributed to transfusions and has less to do with ineffective erythropoiesis. Diagnosis might be challenging; a normal hemoglobin electrophoresis should not rule out the diagnosis of unstable hemoglobin in patients with otherwise unexplained hemolytic anemia. This series shows the enormous utility of using molecular techniques for diagnosis.
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Affiliation(s)
- Linet Njue
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Cesare Medri
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Peter Keller
- Hematology, Spital Langenthal SRO AG, 4900, Langenthal, Switzerland
| | - Miriam Diepold
- Hematology and Oncology, Children's Hospital, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Behrouz Mansouri Taleghani
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland
| | - Alicia Rovó
- Department of Hematology and Central Hematology Laboratory, Inselspital, Bern University Hospital, University of Bern, 3010, Bern, Switzerland.
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21
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Abstract
Red blood cell (RBC) transfusion is critical in managing acute and chronic complications of sickle cell disease. Alloimmunization and iron overload remain significant complications of transfusion therapy and are minimized with prophylactic Rh and K antigen RBC matching and iron chelation. Matched sibling donor hematopoietic stem cell transplant (HSCT) is a curative therapeutic option. Autologous hematopoietic stem cell (HSC)-based gene therapy has recently shown great promise, for which obtaining sufficient HSCs is essential for success. This article discusses RBC transfusion indications and complications, transfusion support during HSCT, and HSC mobilization and collection for autologous HSCT with gene therapy.
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Affiliation(s)
- Yan Zheng
- Department of Pathology, St. Jude Children's Research Hospital, MS 342, 262 Danny Thomas Place, Memphis, TN 38105, USA
| | - Stella T Chou
- Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 3615 Civic Center Boulevard, Abramson Research Center Room 316D, Philadelphia, PA 19010, USA.
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22
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Oyedeji CI, Crawford RD, Shah N. Adherence to Iron Chelation Therapy with Deferasirox Formulations among Patients with Sickle Cell Disease and β-thalassemia. J Natl Med Assoc 2020; 113:170-176. [PMID: 32892996 DOI: 10.1016/j.jnma.2020.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/09/2020] [Accepted: 08/12/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Individuals with hemoglobinopathies experience complications that often require management with multiple transfusions. These chronic transfusions can lead to iron overload, which places them at increased risk of organ damage, malignancy, and even death. Deferasirox is the most common iron chelator used to treat iron overload due to its safety, efficacy, and oral administration. The first formulation of deferasirox, a dispersible tablet for oral suspension (DT) called Exjade®, was associated with adherence challenges due to complaints from poor taste and side effects such as abdominal discomfort. A new film-coated tablet formulation (FCT) called Jadenu® was subsequently developed to overcome these challenges. OBJECTIVE The objective of this study was to compare adherence rates between formulations of deferasirox (DT versus FCT) and describe associations between adherence to chelation therapy and changes in hematological parameters among patients with SCD and β-thalassemia. METHODS In this retrospective study of 20 children and adults with sickle cell disease (SCD) and β-thalassemia with iron overload, we compared adherence rates for deferasirox DT versus deferasirox FCT. We reviewed data from the electronic medical record and pharmacy expense reports between 2014 and 2018. We calculated the mean medication possession ratio (MPR) and analyzed the mean paired difference in MPR and ferritin levels using paired sample t-test. RESULTS The overall mean MPR was 0.15 (0.25) for deferasirox DT and 0.44 (0.32) for deferasirox FCT. The mean paired difference in MPR when transitioning from deferasirox DT to deferasirox FCT was +0.29, p-value < 0.01 (95% CI: 0.19, 0.39). The mean paired difference in ferritin while on deferasirox DT compared to ferritin 6 months after transitioning to deferasirox FCT was -306 ng/mL p-value = 0.14 (95% CI: 719, 113). CONCLUSION There was significant improvement in adherence to iron chelation therapy when patients transitioned from deferasirox DT to deferasirox FCT.
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Affiliation(s)
- Charity I Oyedeji
- Division of Hematology, Duke University School of Medicine Durham, NC, USA.
| | - Regina D Crawford
- Division of Hematology, Duke University School of Medicine Durham, NC, USA; Department of Medicine, Duke Comprehensive Sickle Cell Center, Duke University School of Medicine Durham, NC, USA
| | - Nirmish Shah
- Division of Hematology, Duke University School of Medicine Durham, NC, USA; Department of Medicine, Duke Comprehensive Sickle Cell Center, Duke University School of Medicine Durham, NC, USA; Division of Pediatric Hematology/Oncology, Duke University School of Medicine Durham, NC, USA
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23
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Hacking SM. Red blood cell exchange for SARS-CoV-2: A Gemini of therapeutic opportunities. Med Hypotheses 2020; 144:110227. [PMID: 33254534 PMCID: PMC7467009 DOI: 10.1016/j.mehy.2020.110227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 08/28/2020] [Indexed: 01/25/2023]
Abstract
As of now, therapeutic strategies for the novel coronavirus (SARS-CoV-2) are limited and much focus has been placed on social distancing techniques to “flatten the curve”. Initial treatment efforts including ventilation and hydroxychloroquine garnered significant controversy and today, SARS-CoV-2 outbreaks are still occurring throughout the world. Needless to say, new therapeutic strategies are needed to combat this unprecedented pandemic. Nature Reviews Immunology recently published an article hypothesizing the pathogenesis of TAM (Tyro3, Axl, and Mer) receptor signaling in COVID-19. In it they expressed that hypercoagulation and immune hyper-reaction could occur secondary to decreased Protein S (PROS1). And hypoxia has been recently discovered to significantly decrease expression of PROS1. Regarding the cause of hypoxia in COVID-19; NIH funded research utilizing state-of-the-art topologies has recently demonstrated significant metabolomic, proteomic, and lipidomic structural aberrations in hemoglobin (Hb) secondary to infection with SARS-CoV-2. In this setting, Hb may be incapacitated and unable to respond to environmental variations, compromising RBCs and oxygen delivery to tissues. The use of red blood cell exchange would target hypoxia at its source; representing a Gemini of therapeutic opportunities.
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Affiliation(s)
- Sean M Hacking
- Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Northwell, New York, USA.
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Jensen RFG, Dziegiel MH, Rieneck K, Birgens H, Glenthøj A. Erythrocytapheresis as a novel treatment option for adult patients with pyruvate kinase deficiency. Haematologica 2020; 105:e373-e375. [PMID: 32273473 DOI: 10.3324/haematol.2020.246686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Rawia F G Jensen
- Danish Center for Hemoglobinopathies, Department of Hematology, Herlev and Gentofte Hospital, Herlev
| | - Morten H Dziegiel
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen.,Department of Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | - Klaus Rieneck
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen
| | - Henrik Birgens
- Danish Center for Hemoglobinopathies, Department of Hematology, Herlev and Gentofte Hospital, Herlev
| | - Andreas Glenthøj
- Danish Center for Hemoglobinopathies, Department of Hematology, Herlev and Gentofte Hospital, Herlev
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25
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Mansouri Taleghani B, Buser A. Therapeutic Apheresis. Transfus Med Hemother 2019; 46:391-393. [PMID: 31933568 PMCID: PMC6944895 DOI: 10.1159/000504143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 01/04/2023] Open
Affiliation(s)
- Behrouz Mansouri Taleghani
- University Clinic of Hematology and Central Hematology Laboratory, Division of Transfusion Medicine, Bern University Hospital, Inselspital, Bern, Switzerland
| | - Andreas Buser
- Regional Blood Transfusion Service Swiss Red Cross Basel, and Department of Hematology, University Hospital Basel, Basel, Switzerland
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