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Kotb A, Alzahrani H, Alahmari A, Syed Osman Ahmed, Alhayli S, Shaheen M, Chaudhri N, Alsharif F, Hanbali A, Alfraih F, Alshaibani A, Albabtain AA, Alfayez M, Alotaibi AS, Elhassan T, Rasheed W, Almohareb F, Aljurf M, El Fakih R. Incidence and risk factors for secondary graft failure in uniformly treated patients with severe aplastic anemia receiving fludarabine and cyclophosphamide for conditioning and matched sibling bone marrow graft as stem cell source. Cytotherapy 2023; 25:1331-1337. [PMID: 37737766 DOI: 10.1016/j.jcyt.2023.08.009] [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: 03/07/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND AIMS Graft failure after allogeneic transplant for aplastic anemia is problematic. The risk of graft failure depends on multiple variables, including the preparative regimen, donor type, stem cell dose and source among other variables. METHODS We performed a retrospective analysis of patients with aplastic anemia who underwent matched-sibling allogeneic transplant at a single center. RESULTS We identified 82 patients who fit the inclusion criteria. One had primary graft failure and was excluded from this analysis. The recipient median age was 22 years. The donor median age was 23 years. The median time from diagnosis to transplant was 1.6 months. The median number of red cell transfusions before transplant was nine. The median number of platelet transfusions before transplant was 18. Thirteen patients developed secondary graft failure, with a cumulative incidence at 5 years of 16% and median time to develop secondary graft failure of 129 days. All patients engrafted with a median time for neutrophil engraftment of 19 days and a median time for platelet engraftment of 22 days. The survival of patients with or without secondary graft failure was not different. Major or bidirectional ABO incompatibility and older recipient age were statistically significantly associated with greater risk of secondary graft failure. CONCLUSIONS Secondary graft failure is a significant complication after allogeneic transplant for SAA. Identification of recipients at risk and mitigating the potential risks of this complication is warranted.
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Affiliation(s)
- Ahmed Kotb
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; Hematology Unit, Department of Medicine, Zagazig University, Zagazig, Egypt
| | - Hazzaa Alzahrani
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ali Alahmari
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Syed Osman Ahmed
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Saud Alhayli
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Marwan Shaheen
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Naeem Chaudhri
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fahad Alsharif
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Amr Hanbali
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Feras Alfraih
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Alfadel Alshaibani
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | | | - Mansour Alfayez
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Ahmad S Alotaibi
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Tusneem Elhassan
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Walid Rasheed
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Fahad Almohareb
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mahmoud Aljurf
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Riad El Fakih
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia; School of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
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Al-Omran AM, Shapan HA, Al-Abdi SY. A retrospective comparison of phototherapy need in O-B versus O-A incompatibility in a single Saudi institution. J Neonatal Perinatal Med 2023:NPM221136. [PMID: 37182846 DOI: 10.3233/npm-221136] [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: 05/16/2023]
Abstract
BACKGROUND ABO incompatibility is a major risk factor for neonatal indirect hyperbilirubinemia (NIH), requiring treatment. It has been shown that there are racial differences in direct antiglobulin test (DAT) positivity and phototherapy need in the O--B versus (vs) O--A incompatibility. The comparison between the O--B and O--A incompatibility is not well studied in Saudi Arabia. AIMS We aimed to compare DAT positivity and phototherapy need in O-B vs O-A incompatibility in Saudi Arabia. METHODS This retrospective cohort study was conducted in one Saudi hospital. We included a convenience sample of neonates born between 01 January 2013 and 31 December 2021. We included healthy neonates admitted to the nursery care unit only, born at≥38 weeks gestation, and had normal G6PD levels. Neonates that had no G6PD level measurement or lost follow-up post-discharge were excluded. The data span was the first 14 days of life. RESULTS A total of 611 neonates met our inclusion criteria. Positive DAT was more prevalent in the O-B than the O-A incompatibility [43.5% vs 29.2%, p < 0.001). A greater odd of phototherapy need was observed in the O--B vs O-A incompatibility across various strata. Readmission for NIH, use of 360° exposure phototherapy, or intravenous immunoglobulin administration was more prevalent in the O-B than the O-A incompatibility (13.2% vs 5.0%, p < 0.001). A logistic regression analysis revealed that the O-B incompatibility modified the association between DAT positivity and phototherapy need. CONCLUSIONS The O-B incompatibility had a mediator effect on the relationship between DAT positivity and the need for phototherapy in the study population, which emphasizes that the O-B and O-A are not the same from the NIH point of view.
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Affiliation(s)
- A M Al-Omran
- Department of Pediatrics, Almana General Hospital, Al-Ahsa, Saudi Arabia
| | - H A Shapan
- Department of Pediatrics, Almana General Hospital, Al-Ahsa, Saudi Arabia
| | - S Y Al-Abdi
- Department of Pediatrics, King Abdulaziz Hospital, Ministry of National Guard Hospital, Al-Ahsa, Saudi Arabia
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Garraud O, Hamzeh-Cognasse H, Chalayer E, Duchez AC, Tardy B, Oriol P, Haddad A, Guyotat D, Cognasse F. Platelet transfusion in adults: An update. Transfus Clin Biol 2023; 30:147-165. [PMID: 36031180 DOI: 10.1016/j.tracli.2022.08.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Many patients worldwide receive platelet components (PCs) through the transfusion of diverse types of blood components. PC transfusions are essential for the treatment of central thrombocytopenia of diverse causes, and such treatment is beneficial in patients at risk of severe bleeding. PC transfusions account for almost 10% of all the blood components supplied by blood services, but they are associated with about 3.25 times as many severe reactions (attributable to transfusion) than red blood cell transfusions after stringent in-process leukoreduction to less than 106 residual cells per blood component. PCs are not homogeneous, due to the considerable differences between donors. Furthermore, the modes of PC collection and preparation, the safety precautions taken to limit either the most common (allergic-type reactions and febrile non-hemolytic reactions) or the most severe (bacterial contamination, pulmonary lesions) adverse reactions, and storage and conservation methods can all result in so-called PC "storage lesions". Some storage lesions affect PC quality, with implications for patient outcome. Good transfusion practices should result in higher levels of platelet recovery and efficacy, and lower complication rates. These practices include a matching of tissue ABH antigens whenever possible, and of platelet HLA (and, to a lesser extent, HPA) antigens in immunization situations. This review provides an overview of all the available information relating to platelet transfusion, from donor and donation to bedside transfusion, and considers the impact of the measures applied to increase transfusion efficacy while improving safety and preventing transfusion inefficacy and refractoriness. It also considers alternatives to platelet component (PC) transfusion.
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Affiliation(s)
- O Garraud
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France.
| | | | - E Chalayer
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France; Saint-Etienne University Hospital, Department of Hematology and Cellular Therapy, Saint-Étienne, France
| | - A C Duchez
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France; Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France
| | - B Tardy
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France; CHU de Saint-Etienne, INSERM and CIC EC 1408, Clinical Epidemiology, Saint-Étienne, France
| | - P Oriol
- CHU de Saint-Etienne, INSERM and CIC EC 1408, Clinical Epidemiology, Saint-Étienne, France
| | - A Haddad
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France; Sacré-Cœur Hospital, Beirut, Lebanon; Lebanese American University, Beirut, Lebanon
| | - D Guyotat
- Saint-Etienne University Hospital, Department of Hematology and Cellular Therapy, Saint-Étienne, France
| | - F Cognasse
- SAINBIOSE, INSERM, U1059, University of Lyon, Saint-Étienne, France; Établissement Français du Sang Auvergne-Rhône-Alpes, Saint-Étienne, France
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ABO Incompatibility between the Mother and Fetus Does Not Protect against Anti-Human Platelet Antigen-1a Immunization by Pregnancy. J Clin Med 2022; 11:jcm11226811. [PMID: 36431288 PMCID: PMC9694632 DOI: 10.3390/jcm11226811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 11/07/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022] Open
Abstract
(1) Background: ABO blood group incompatibility between the mother and fetus protects against anti-D immunization by pregnancy. The possible role of ABO incompatibility in protecting against anti-human platelet antigen-1a immunization is unclear. (2) Methods: This study retrospectively screened 817 families (mother-father-neonate trios) of suspected fetal and neonatal alloimmune thrombocytopenia for inclusion. ABO genotypes were determined in 118 mother-child pairs with confirmed alloimmune thrombocytopenia due to anti-HPA-1a antibodies, and 522 mother-child pairs served as the control group. The expression of blood group antigen A on platelets was determined in 199 consecutive newborns by flow cytometry and compared with adult controls. (3) Results: ABO incompatibility between mother and fetus did not protect against anti-human platelet antigen-1a immunization by pregnancy. ABO blood groups of mothers and/or fetuses were not associated with the severity of fetal and neonatal alloimmune thrombocytopenia. The expression pattern of blood group A antigens on the platelets of newborns mirrored that of adults, albeit on a lower level. Blood group A antigen was detected on a subpopulation of neonatal platelets, and some newborns revealed high platelet expression of A determinants on all platelets (type II high-expressers). (4) Conclusion: The lack of a protective effect of ABO incompatibility between mother and fetus against anti-human platelet antigen-1a immunization by pregnancy may indicate that fetal platelets are not the cellular source by which the mother is immunized.
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Al-Abdi SY, Al-Omran AM, Shapan HA. Cord Platelet Count of Full-Term Neonates in Relation to ABO Incompatibility and Glucose-6-Phosphate Dehydrogenase Levels: A Retrospective Cohort Study. Cureus 2022; 14:e30284. [PMID: 36407223 PMCID: PMC9654656 DOI: 10.7759/cureus.30284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2022] [Indexed: 05/28/2023] Open
Abstract
Background The immunoglobulin G of mothers with O blood type may sensitize the platelets of their neonates with A (O-A incompatibility) or B (O-B incompatibility) blood type. As the expression and antigenicity of the B antigen on platelets is less than that of the A antigens, we have hypothesized that platelet count is higher in the O-B incompatibility group compared to the O-A incompatibility group. There is controversy about whether glucose-6-phosphate dehydrogenase (G6PD) deficiency, without evidence of hemolysis, is associated with a lower platelet count than G6PD-normal. Aim To assess whether platelet count is higher in the O-B than in the O-A incompatible neonates and whether it correlates with their G6PD levels. Methods This study was a retrospective cohort study on a sample of 835 healthy neonates born at ≥38 weeks gestation who were either A or B blood types with mothers that carried the blood type O Rh-positive. The platelet count (thousand per microliter) from umbilical cord venous blood (UCVB) was used. A G6PD level of 11.0 units/gram of hemoglobin (U/g Hb) was considered the lower reference limit. G6PD deficiency was defined as a G6PD level of <3.3 U/g Hb in both sexes. Intermediate G6PD deficiency in females was described as a G6PD level of 3.3-8.8 U/g Hb. Results The mean UCVB platelet count was higher in female neonates compared to male neonates (n=389, 283±65 versus n=446, 272±73, p=0.01). The mean UCVB platelet count was higher in the O-B incompatibility group in both male (n=114, 291±82 versus n=103, 266±63) and female neonates (n=83, 303±66 versus n=81, 278±58) with G6PD levels of >8.8 U/g Hb. There was a positive weak correlation between UCVB platelet counts and G6PD levels only in O-B incompatible female neonates (n=176, r=0.23, p=0.002). The partitioning and combined 95% reference intervals (RIs) of the UCVB platelet count were presented. Conclusion The platelet count was higher in the O-B incompatibility group compared to the O-A incompatibility group, but only when the G6PD level was >8.8 U/g Hb. A correlation between UCVB platelet count and G6PD levels was found only among O-B incompatible female neonates. These findings may have an important implication in estimating RIs of the UCVB platelet count, however, they need to be confirmed and explored in future research.
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Chavali S, Raju S, Kanasani S, Gabbita AC. Management of a Patient with Bombay Blood Group and Chronic Liver Disease with Subdural Hematoma. JOURNAL OF NEUROANAESTHESIOLOGY AND CRITICAL CARE 2022. [DOI: 10.1055/s-0042-1744402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractThe Bombay blood group is an extremely rare entity within the conventional ABO blood grouping system. End-stage liver disease also presents with myriad disorders of coagulation due to impaired synthesis and dysfunction of clotting factors, which predisposes patients to spontaneous and life-threatening episodes of bleeding. We report a patient with Bombay blood group and end-stage liver disease who presented to our hospital with a spontaneous subdural hematoma. Although conventional parameters of coagulation in this patient were abnormal, we were able to safely defer product transfusion because his thromboelastography (TEG) report was within acceptable ranges. In this article, we discuss our strategy for optimization of extremely limited blood resources in this scenario and perioperative strategies for the management of coagulation anomalies in patients with liver dysfunction.
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Affiliation(s)
- Siddharth Chavali
- Institute of Neurosciences, AIG Hospitals, Gachibowli, Hyderabad, Telangana, India
| | - Subodh Raju
- Institute of Neurosciences, AIG Hospitals, Gachibowli, Hyderabad, Telangana, India
| | - Suresh Kanasani
- Institute of Neurosciences, AIG Hospitals, Gachibowli, Hyderabad, Telangana, India
| | - Abhirama C. Gabbita
- Institute of Neurosciences, AIG Hospitals, Gachibowli, Hyderabad, Telangana, India
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A Prospective Observational Study To Compare Transfusion Outcomes In Abo Identical Versus Abo Non-Identical Single Donor Platelet Concentrates: An Experience From A Tertiary Healthcare Center In India. Transfus Clin Biol 2022; 29:213-218. [PMID: 35667592 DOI: 10.1016/j.tracli.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/27/2022] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
ABO incompatible single donor platelet concentrates (SDPC) have a concern about unsatisfactory increments as well as possibility of hemolytic transfusion reaction. But from Indian population no study has commented on the clinical and laboratory outcome of ABO mismatched platelet transfusion. The aim of study was to compare transfusion outcomes in ABO identical versus ABO non-identical single donor platelet concentrates. In this prospective observational study, 400 SDPC transfusions among different patients were included. In group A (n = 200), ABO identical SDPC transfusions and in group B (n = 200) ABO non-identical SDPC transfusions were added. Corrective count increment (CCI), absolute count increment (ACI), percent platelet recovery (PPR) were calculated and incidents of hemolytic transfusion reactions were noted. In group A mean ± SD of ACI, CCI and PPR were as 30.78 ± 12.51, 15.10 ± 6.677, 39948.9 ± 20099.392. In group B, mean ± SD of ACI, CCI and PPR were - 25.4 ± 15.65, 12.509 ± 5.906, 33559.2 ± 22150.304. And when CCI, ACI, PPR were compared with group A and group B, statistically significant differences were noted (p <0.05). There was statistically significant difference in CCI, ACI and PPR in oncology patients and other prophylactic recipients except patients with dengue and other infectious disease. But there was no hemolytic transfusion reaction noted in any group. Our study clearly establish the potential benefits of ABO-identical PLT transfusion. It also points out that in emergency conditions or when there is a paucity in inventory, ABO non-identical SDPC transfusion may be lifesaving and clinically significant.
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Low VWF: insights into pathogenesis, diagnosis, and clinical management. Blood Adv 2021; 4:3191-3199. [PMID: 32663299 DOI: 10.1182/bloodadvances.2020002038] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/29/2020] [Indexed: 01/17/2023] Open
Abstract
von Willebrand disease (VWD) constitutes the most common inherited human bleeding disorder. Partial quantitative von Willebrand factor (VWF) deficiency is responsible for the majority of VWD cases. International guidelines recommend that patients with mild to moderate reductions in plasma VWF antigen (VWF:Ag) levels (typically in the range of 30-50 IU/dL) should be diagnosed with low VWF. Over the past decade, a series of large cohort studies have provided significant insights into the biological mechanisms involved in type 1 VWD (plasma VWF:Ag levels <30 IU/dL). In striking contrast, however, the pathogenesis underpinning low VWF has remained poorly understood. Consequently, low VWF patients continue to present significant clinical challenges with respect to genetic counseling, diagnosis, and management. For example, there is limited information regarding the relationship between plasma VWF:Ag levels and bleeding phenotype in subjects with low VWF. In addition, it is not clear whether patients with low VWF need treatment. For those patients with low VWF in whom treatment is deemed necessary, the optimal choice of therapy remains unknown. However, a number of recent studies have provided important novel insights into these clinical conundrums and the molecular mechanisms responsible for the reduced levels observed in low VWF patients. These emerging clinical and scientific findings are considered in this review, with particular focus on pathogenesis, diagnosis, and clinical management of low VWF.
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Predictive modeling of complex ABO glycan phenotypes by lectin microarrays. Blood Adv 2021; 4:3960-3970. [PMID: 32822483 DOI: 10.1182/bloodadvances.2020002051] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 07/21/2020] [Indexed: 12/18/2022] Open
Abstract
Serological classification of individuals as A, B, O, or AB is a mainstay of blood banking. ABO blood groups or ABH antigens, in addition to other surface glycans, act as unique red blood cell (RBC) signatures and direct immune responses. ABO subgroups present as weakened, mixed field, or unexpected reactivity with serological reagents, but specific designations remain complex. Lectins detect glycan motifs with some recognizing ABH antigens. We evaluated a 45-probe lectin microarray to rapidly analyze ABO blood groups and associated unique glycan signatures within complex biological samples on RBC surface glycoproteins. RBC membrane glycoproteins were prepared from donor RBCs, n = 20 for each blood group. ABO blood group was distinguishable by lectin array, including variations in ABH antigen expression not observed with serology. Principal component analysis highlighted broad ABO blood group clusters with unexpected high and low antigen expression and variations were confirmed with ABH antibody immunoblotting. Using a subset of lectins provided an accurate method to predict an ABO serological phenotype. Lectin microarray highlighted the importance of ABO localization on glycoproteins and glycolipids and pointed to increased glycocalyx complexity associated with the expression of A and B antigens including high mannose and branched polylactosamine. Thus, lectins identified subtle surface ABO blood group glycoprotein density variations not detected by routine serological methods. Transfusion services observe alterations in ABH expression during malignancy, and ABO incompatible solid organ transplantation is not without risk of rejection. The presented methods may identify subtle but clinically significant ABO blood group differences for transfusion and transplantation.
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Rethinking platelet transfusion practices. Blood 2021; 137:2576-2577. [PMID: 33983425 DOI: 10.1182/blood.2021011269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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The relationship between ABO blood group, von Willebrand factor, and primary hemostasis. Blood 2021; 136:2864-2874. [PMID: 32785650 DOI: 10.1182/blood.2020005843] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 08/03/2020] [Indexed: 12/16/2022] Open
Abstract
Numerous studies have reported significant associations between ABO blood group and risk of cardiovascular disease. These studies have consistently demonstrated that thrombotic risk is significantly reduced in individuals in blood group O. Nevertheless, the biological mechanisms through which ABO influences hemostasis have remained poorly understood. Exciting recent data have provided novel insights into how these ABO effects are modulated and have highlighted that ABO group significantly influences platelet plug formation at sites of vascular injury (primary hemostasis). In particular, ABO affects multiple aspects of von Willebrand factor (VWF) biology. In keeping with their reduced thrombotic risk, plasma VWF levels are ∼25% lower in healthy group O compared with healthy group non-O individuals. In addition, blood group O VWF demonstrates enhanced susceptibility to ADAMTS13 proteolysis. Finally, preliminary findings suggest that the interaction of group O VWF with platelets may also be reduced. Although the molecular mechanisms underlying these ABO effects on VWF have not been fully elucidated, it seems likely that they are mediated in large part by the ABO(H) carbohydrate structures that are carried on both the N- and O-linked glycans of VWF. Interestingly, ABO(H) determinants are also expressed on several different platelet surface glycoprotein receptors. Recent studies support the hypothesis that ABO group not only exerts major quantitative and qualitative effects on VWF, but also affect specific aspects of platelet function. Given the severe morbidity and the mortality associated with thrombotic disorders, defining the mechanisms underlying these ABO effects is not only of scientific interest, but also of direct clinical importance.
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Szymczak-Kulus K, Weidler S, Bereznicka A, Mikolajczyk K, Kaczmarek R, Bednarz B, Zhang T, Urbaniak A, Olczak M, Park EY, Majorczyk E, Kapczynska K, Lukasiewicz J, Wuhrer M, Unverzagt C, Czerwinski M. Human Gb3/CD77 synthase produces P1 glycotope-capped N-glycans, which mediate Shiga toxin 1 but not Shiga toxin 2 cell entry. J Biol Chem 2021; 296:100299. [PMID: 33460651 PMCID: PMC7949097 DOI: 10.1016/j.jbc.2021.100299] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 01/07/2021] [Accepted: 01/12/2021] [Indexed: 12/15/2022] Open
Abstract
The human Gb3/CD77 synthase, encoded by the A4GALT gene, is an unusually promiscuous glycosyltransferase. It synthesizes the Galα1→4Gal linkage on two different glycosphingolipids (GSLs), producing globotriaosylceramide (Gb3, CD77, Pk) and the P1 antigen. Gb3 is the major receptor for Shiga toxins (Stxs) produced by enterohemorrhagic Escherichia coli. A single amino acid substitution (p.Q211E) ramps up the enzyme's promiscuity, rendering it able to attach Gal both to another Gal residue and to GalNAc, giving rise to NOR1 and NOR2 GSLs. Human Gb3/CD77 synthase was long believed to transfer Gal only to GSL acceptors, therefore its GSL products were, by default, considered the only human Stx receptors. Here, using soluble, recombinant human Gb3/CD77 synthase and p.Q211E mutein, we demonstrate that both enzymes can synthesize the P1 glycotope (terminal Galα1→4Galβ1→4GlcNAc-R) on a complex type N-glycan and a synthetic N-glycoprotein (saposin D). Moreover, by transfection of CHO-Lec2 cells with vectors encoding human Gb3/CD77 synthase and its p.Q211E mutein, we demonstrate that both enzymes produce P1 glycotopes on N-glycoproteins, with the mutein exhibiting elevated activity. These P1-terminated N-glycoproteins are recognized by Stx1 but not Stx2 B subunits. Finally, cytotoxicity assays show that Stx1 can use P1 N-glycoproteins produced in CHO-Lec2 cells as functional receptors. We conclude that Stx1 can recognize and use P1 N-glycoproteins in addition to its canonical GSL receptors to enter and kill the cells, while Stx2 can use GSLs only. Collectively, these results may have important implications for our understanding of the Shiga toxin pathology.
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Affiliation(s)
- Katarzyna Szymczak-Kulus
- Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland
| | - Sascha Weidler
- Department of Bioorganic Chemistry, University of Bayreuth, Bayreuth, Germany
| | - Anna Bereznicka
- Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland
| | - Krzysztof Mikolajczyk
- Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland
| | - Radoslaw Kaczmarek
- Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland
| | - Bartosz Bednarz
- Laboratory of Molecular Biology of Microorganisms, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland
| | - Tao Zhang
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Anna Urbaniak
- Department of Biochemistry and Molecular Biology, Faculty of Veterinary Medicine, Wroclaw University of Environmental and Life Sciences, Wroclaw, Poland
| | - Mariusz Olczak
- Department of Biochemistry, Faculty of Biotechnology, University of Wroclaw, Wroclaw, Poland
| | - Enoch Y Park
- Laboratory of Biotechnology, Shizuoka University, Shizuoka, Japan
| | - Edyta Majorczyk
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Opole, Poland
| | - Katarzyna Kapczynska
- Laboratory of Medical Microbiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland
| | - Jolanta Lukasiewicz
- Laboratory of Microbial Immunochemistry and Vaccines, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland
| | - Manfred Wuhrer
- Center for Proteomics and Metabolomics, Leiden University Medical Center, Leiden, The Netherlands
| | - Carlo Unverzagt
- Department of Bioorganic Chemistry, University of Bayreuth, Bayreuth, Germany
| | - Marcin Czerwinski
- Laboratory of Glycobiology, Hirszfeld Institute of Immunology and Experimental Therapy, Wroclaw, Poland.
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O'Donghaile D, Jenkins PV, McGrath RT, Preston L, Field SP, Ward SE, O'Sullivan JM, O'Donnell JS. Expresser phenotype determines ABO(H) blood group antigen loading on platelets and von Willebrand factor. Sci Rep 2020; 10:18366. [PMID: 33110150 PMCID: PMC7591562 DOI: 10.1038/s41598-020-75462-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 10/15/2020] [Indexed: 01/22/2023] Open
Abstract
ABO blood group is associated with cardiovascular disease, with significantly lower risk in blood group O individuals. ABO(H) blood group determinants are expressed on different glycoproteins on platelet surfaces. In addition, ABO(H) structures are also present on VWF glycans. These ABO(H) carbohydrates influence both platelet and VWF function. Previous studies have reported that approximately 5-10% of normal blood donors express abnormally high or low levels of A or B blood group antigens on their platelet surfaces (high expresser phenotype, HXP or low expresser phenotype, LXP respectively). In this study, the biological effects of the ABO Expresser phenotype were investigated. ABO(H) expression on platelets and plasma VWF was studied in a series of 541 healthy blood donors. Overall, 5.6% of our study cohort were classified as HXP, whilst 4.4% satisfied criteria for LXP. We demonstrate that genotype at the ABO blood group locus plays a critical role in modulating the platelet HXP phenotype. In particular, A1A1 genotype is a major determinant of ABO high-expresser trait. Our data further show that ABH loading on VWF is also affected by ABO expresser phenotype. Consequently, A antigen expression on VWF was significantly elevated in HXP individuals and moderately reduced in LXP subjects (P < 0.05). Collectively, these findings suggest that ABO expresser phenotype influences primary hemostasis though several different pathways. Further studies will be required to define whether inter-individual variations in ABO(H) expression on platelets and/or VWF (particularly HXP and LXP) impact upon risk for cardiovascular disease.
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Affiliation(s)
- Diarmaid O'Donghaile
- Irish Blood Transfusion Service, Dublin, Ireland
- Department of Haematology, Trinity College Dublin, Dublin, Ireland
| | - P Vincent Jenkins
- Department of Haematology, University Hospital of Wales, Cardiff, Wales, UK
| | - Rachel T McGrath
- National Coagulation Centre, St James's Hospital, Dublin, Ireland
| | - Lisa Preston
- Cancer Molecular Diagnostics, Trinity Centre for Health Sciences, St James's Hospital, Dublin, Ireland
| | | | - Soracha E Ward
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Ardilaun House 111 St Stephen's Green, Dublin 2, Ireland
| | - Jamie M O'Sullivan
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Ardilaun House 111 St Stephen's Green, Dublin 2, Ireland
| | - James S O'Donnell
- Department of Haematology, University Hospital of Wales, Cardiff, Wales, UK.
- Irish Centre for Vascular Biology, School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Ardilaun House 111 St Stephen's Green, Dublin 2, Ireland.
- National Children's Research Centre, Our Lady's Children's Hospital, Dublin, Ireland.
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14
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Abstract
Abstract
Platelet autoantibodies are a common finding in immune thrombocytopenia (ITP) and in rare cases of antibody-mediated platelet function (“acquired thrombasthenia”). In drug-induced immune thrombocytopenia, antibodies react with platelets only in the presence of the offending drug. Alloantibodies reacting with platelets are induced by transfusion of cellular blood products or during pregnancy. They are responsible for fetal/neonatal alloimmune thrombocytopenia (FNAIT), they are able to cause febrile, nonhemolytic transfusion reactions and they give rise to insufficient platelet increments following platelet transfusions. Two rare transfusion reactions: post-transfusion purpura (PTP) and passive alloimmune thrombocytopenia (PAT) are triggered by platelet alloantibodies. This review discusses the clinical value of tests for platelet antibodies in various clinical situations related to insufficient primary hemostasis.
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Affiliation(s)
- Volker Kiefel
- Institut für Transfusionsmedizin , Universitätsmedizin Rostock , Ernst-Heydemann-Str. 6 , 18057 Rostock , Germany
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15
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Solves Alcaina P. Platelet Transfusion: And Update on Challenges and Outcomes. J Blood Med 2020; 11:19-26. [PMID: 32158298 PMCID: PMC6986537 DOI: 10.2147/jbm.s234374] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 12/31/2019] [Indexed: 12/29/2022] Open
Abstract
Platelet transfusion is a common practice in onco-hematologic patients for preventing or treating hemorrhages. Platelet concentrates can be transfused with therapeutic or prophylactic purposes. With the aim to help clinicians to take the decisions on platelet transfusion, some guidelines have been developed based on the current scientific evidence. However, there are some controversial issues and available scientific evidence is not enough to solve them. There is little information about what is the best platelet product to be transfused: random platelets or single donor apheresis platelets, and plasma-suspended or additive solution suspended platelets. Platelets are often transfused without respecting the ABO compatibility, but influence of this practice on platelet transfusion outcome is not well established. In the prophylactic platelet transfusion set there are some questions unsolved as the platelet threshold to transfuse prior to specific procedures or surgery, and even if platelet transfusion is necessary for some specific procedures as autologous hematopoietic stem cell transplantation. A challenging complication raised from multiple platelet transfusions is the platelet transfusion refractoriness. The study and management of this complication is often disappointing. In summary, although it is a widespread practice, platelet transfusion has still many controversial and unknown issues. The objective of this article is to review the current evidence on platelet transfusion practices, focusing on the controversial issues and challenges.
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Affiliation(s)
- Pilar Solves Alcaina
- Blood Bank, Hematology Service, Hospital Universitari I Politècnic La Fe, Valencia, CIBERONC, Instituto Carlos III, Madrid, Spain
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16
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Ma YR, Wang WJ, Cheng YF, Zhang YY, Mo XD, Han TT, Wang FR, Yan CH, Sun YQ, Chen YH, Wang JZ, Tang FF, Han W, Wang Y, Zhang XH, Huang XJ, Xu LP. Impact of ABO incompatibility on outcomes after haploidentical hematopoietic stem cell transplantation for severe aplastic anemia. Bone Marrow Transplant 2020; 55:1068-1075. [PMID: 31932654 DOI: 10.1038/s41409-020-0779-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/11/2019] [Accepted: 01/02/2020] [Indexed: 12/15/2022]
Abstract
The impact of ABO incompatibility on transplantation outcomes in severe aplastic anemia (SAA) patients receiving haploidentical hematopoietic stem cell transplantation (HSCT) remains controversial without published data. A total of 199 SAA patients receiving haploidentical HSCT from ABO-matched (n = 114), minor ABO-incompatible (n = 47), or major ABO-incompatible donors (n = 38) were included in this study. The median time and cumulative incidences of both myeloid and platelet engraftment in the ABO-compatible and ABO-incompatible groups were similar, and pure red cell aplasia was absent. Minor ABO incompatibility increased the rate of grade III-IV acute graft-versus-host disease (aGVHD) (ABO compatible: 6.14 ± 0.05%, minor incompatible: 19.15 ± 0.34%, and major incompatible: 10.53 ± 0.25%; P = 0.051), but did not influence the rates of grade II-IV aGVHD or chronic GVHD (cGVHD). Minor ABO-incompatibility was identified as an independent risk factor for grade III-IV aGVHD by multivariate analysis (hazard ration (HR) = 4.00 (1.48-10.80), P = 0.006). Chronic GVHD, mortality, and treatment failure were not increased in the minor ABO-incompatible group. For SAA patients receiving haploidentical HSCT, ABO compatible donors are better than ABO minor incompatible donors if several haploidentical donors are available.
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Affiliation(s)
- Yan-Ru Ma
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Wen-Jing Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Yi-Fei Cheng
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Yuan-Yuan Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Xiao-Dong Mo
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Ting-Ting Han
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Feng-Rong Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Chen-Hua Yan
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Yu-Qian Sun
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Yu-Hong Chen
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Jing-Zhi Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Fei-Fei Tang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Wei Han
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Xiao-Hui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Xiao-Jun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.,Peking-Tsinghua Center for Life Sciences, Beijing, 100044, China
| | - Lan-Ping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
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17
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18
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Abstract
Pediatric oncology patients will likely require numerous transfusions of blood products, including red blood cell, platelet, and plasma transfusions, during the course of their treatment. Although strong evidence-based guidelines for these products in this patient population do not exist, given the morbidities associated with the receipt of blood products, practitioners should attempt to use restrictive transfusion strategies.
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19
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Nellis ME, Goel R, Karam O, Cushing MM, Davis PJ, Steiner ME, Tucci M, Stanworth SJ, Spinella PC. Effects of ABO Matching of Platelet Transfusions in Critically Ill Children. Pediatr Crit Care Med 2019; 20:e61-e69. [PMID: 30422914 PMCID: PMC6709973 DOI: 10.1097/pcc.0000000000001779] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To determine if transfusing ABO compatible platelets has a greater effect on incremental change in platelet count as compared to ABO incompatible platelets in critically ill children. DESIGN Secondary analysis of a prospective, observational study. Transfusions were classified as either ABO compatible, major incompatibility, or minor incompatibility. The primary outcome was the incremental change in platelet count. Transfusion reactions were analyzed as a secondary outcome. SETTING Eighty-two PICUs in 16 countries. PATIENTS Children (3 d to 16 yr old) were enrolled if they received a platelet transfusion during one of the predefined screening weeks. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Five-hundred three children were enrolled and had complete ABO information for both donor and recipient, as well as laboratory data. Three-hundred forty-two (68%) received ABO-identical platelets, 133 (26%) received platelets with major incompatibility, and 28 (6%) received platelets with minor incompatibility. Age, weight, proportion with mechanical ventilation or underlying oncologic diagnosis did not differ between the groups. After adjustment for transfusion dose, there was no difference in the incremental change in platelet count between the groups; the median (interquartile range) change for ABO-identical transfusions was 28 × 10 cells/L (8-68 × 10 cells/L), for transfusions with major incompatibility 26 × 10 cells/L (7-74 × 10 cells/L), and for transfusions with minor incompatibility 54 × 10 cells/L (14-81 × 10 cells/L) (p = 0.37). No differences in count increment between the groups were noted for bleeding (p = 0.92) and nonbleeding patients (p = 0.29). There were also no differences observed between the groups for any transfusion reaction (p = 0.07). CONCLUSIONS No differences were seen in the incremental change in platelet count nor in transfusion reactions when comparing major ABO incompatible platelet transfusions with ABO compatible transfusions in a large study of critically ill children. Studies in larger, prospectively enrolled cohorts should be performed to validate whether ABO matching for platelet transfusions in critically ill children is necessary.
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Affiliation(s)
- Marianne E Nellis
- Pediatric Critical Care Medicine, Department of Pediatrics, NY Presbyterian Hospital - Weill Cornell Medicine, New York, NY
| | - Ruchika Goel
- Division of Transfusion Medicine, Department of Pathology, Johns Hopkins University, Baltimore, MD
- Simmons Cancer Institute at SIU School of Medicine, Springfield, IL
| | - Oliver Karam
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, VA
| | | | - Peter J Davis
- Paediatric Intensive Care Unit, Department of Pediatrics, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Marie E Steiner
- Divisions of Pediatric Critical Care and Pediatric Hematology/Oncology, Department of Pediatrics, University of Minnesota, Minneapolis, MN
| | - Marisa Tucci
- Pediatric Intensive Care Unit, Department of Pediatrics, CHU Sainte-Justine, University of Montreal, Montreal, QC, Canada
| | | | - Philip C Spinella
- Department of Pediatrics, Division Critical Care, Washington University in St Louis, St Louis, MO
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20
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The relation between ABO blood types and clinical and platelet function parameters in patients who underwent percutaneous coronary intervention. Coron Artery Dis 2019; 30:51-58. [DOI: 10.1097/mca.0000000000000676] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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21
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22
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Siddon AJ, Tormey CA, Snyder EL. Platelet Transfusion Medicine. Platelets 2019. [DOI: 10.1016/b978-0-12-813456-6.00064-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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23
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Xu X, Xu F, Ying Y, Hong X, Liu Y, Chen S, He J, Zhu F, Hu W. ABO antigen levels on platelets of normal and variant ABO blood group individuals. Platelets 2018; 30:854-860. [DOI: 10.1080/09537104.2018.1543863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Xianguo Xu
- Blood Center of Zhejiang Province, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, China
| | - Fang Xu
- Blood Center of Zhejiang Province, Hangzhou, China
| | - Yanling Ying
- Blood Center of Zhejiang Province, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, China
| | - Xiaozhen Hong
- Blood Center of Zhejiang Province, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, China
| | - Ying Liu
- Blood Center of Zhejiang Province, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, China
| | - Shu Chen
- Blood Center of Zhejiang Province, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, China
| | - Ji He
- Blood Center of Zhejiang Province, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, China
| | - Faming Zhu
- Blood Center of Zhejiang Province, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, China
| | - Wei Hu
- Blood Center of Zhejiang Province, Hangzhou, China
- Zhejiang Provincial Key Laboratory of Blood Safety Research, Hangzhou, China
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24
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Westhoff CM, Storry JR, Shaz BH. Human Blood Group Antigens and Antibodies. Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00110-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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25
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Bonstein L, Haddad N. Taking a wider view on fetal/neonatal alloimmune thrombocytopenia. Thromb Res 2017; 151 Suppl 1:S100-S102. [DOI: 10.1016/s0049-3848(17)30078-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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26
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Damodar S, Shanley R, MacMillan M, Ustun C, Weisdorf D. Donor-to-Recipient ABO Mismatch Does Not Impact Outcomes of Allogeneic Hematopoietic Cell Transplantation Regardless of Graft Source. Biol Blood Marrow Transplant 2017; 23:795-804. [PMID: 28232088 DOI: 10.1016/j.bbmt.2017.02.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/08/2017] [Indexed: 11/30/2022]
Abstract
The impact of ABO mismatch has been studied on various hematopoietic cell transplant (HCT) outcomes, including neutrophil and platelet engraftment, pure red cell aplasia, acute and chronic graft-versus-host disease (GVHD), nonrelapse mortality (NRM), and overall survival (OS). Yet conflicting results have been reported. However, the impact of ABO mismatch on transplant outcomes with various graft types has not been carefully investigated. We analyzed the impact of various graft sources and type of ABO mismatch on transplant outcomes for 1502 patients who underwent HCT at the University of Minnesota between 2000 and 2014: 312 receiving marrow (BM), 475 filgrastim-mobilized blood (peripheral blood stem cell [PBSC]), and 715 umbilical cord blood (UCB) grafts. Neutrophil engraftment by day 28 was marginally less frequent in the bidirectional ABO mismatched transplants receiving UCB, whereas ABO matching had no influence on engraftment in the BM or PBSC cohorts. ABO mismatch led to no significant differences in platelet engraftment irrespective of stem cell source. We observed a modest but not significantly lower incidence of grades II/IV acute GVHD in the bidirectional ABO mismatched transplants in the UCB and the PBSC cohorts but not in the BM group. We found a higher incidence of chronic GVHD in the PBSC group, but it was not significantly lower in the minor ABO mismatched transplants. The incidence of chronic GVHD was similar in the major ABO mismatched transplants receiving BM. We found no significant difference in the OS and NRM between ABO matched and ABO mismatched transplants within each of the 3 graft source groups. Multivariable analysis adjusting for other relevant factors confirmed that ABO match status did not significantly influence the outcomes of either engraftment, acute or chronic GVHD or NRM. We conclude that ABO mismatch does not influence the outcomes of allogeneic HCT, regardless of stem cell source.
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Affiliation(s)
- Sharat Damodar
- Mazumdar Shaw Medical Center, Narayana Health City, Bangalore, India
| | - Ryan Shanley
- University of Minnesota, Blood and Marrow Transplant Program, Minneapolis, Minnesota
| | - Margaret MacMillan
- University of Minnesota, Blood and Marrow Transplant Program, Minneapolis, Minnesota
| | - Celalettin Ustun
- University of Minnesota, Blood and Marrow Transplant Program, Minneapolis, Minnesota
| | - Daniel Weisdorf
- University of Minnesota, Blood and Marrow Transplant Program, Minneapolis, Minnesota.
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27
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Grube M, Wolff D, Ahrens N, Herzberg PY, Herr W, Holler E. ABO blood group antigen mismatch has an impact on outcome after allogeneic peripheral blood stem cell transplantation. Clin Transplant 2016; 30:1457-1465. [PMID: 27618621 DOI: 10.1111/ctr.12840] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 11/29/2022]
Abstract
ABO blood group antigen incompatibility (ABO mismatch) is not an obstacle to allogeneic stem cell transplantation (allo-SCT). However, the impact on clinical outcome after allo-SCT remains controversial. We analyzed 512 patients after allogeneic peripheral blood SCT (allo-PBSCT) for an association of ABO mismatch with transfusion requirements, myeloid and platelet engraftment, the incidence of GvHD, relapse, transplant-related mortality (TRM), and overall survival (OS). A total of 260 patients underwent ABO-mismatched transplantation and the control group consisted of 252 patients with ABO-matched allo-PBSCT. We found a significant association between major-0 ABO mismatch (group 0 recipient/group A, B, or AB donor) and increased red blood cell (RBC) and platelet transfusion requirements (both P<.001) as well as delayed platelet engraftment (P<.001). Minor-A (group A recipient/group 0 donor) and minor-AB (group AB recipient/group 0, A, or B donor) ABO mismatch was significantly associated with an increased TRM after allo-PBSCT (P=.001 and P=.02). In multivariate analysis performed using Cox regression, minor ABO mismatch appeared as independent risk factor for TRM after allo-PBSCT. No association was found for ABO mismatch with the incidence of GvHD, relapse, and OS. Our results suggest that ABO blood group mismatch has a significant impact on the outcome and that minor-A and minor-AB ABO mismatch represents a risk factor for increased TRM after allo-PBSCT.
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Affiliation(s)
- Matthias Grube
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany.
| | - Daniel Wolff
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Norbert Ahrens
- Institute for Laboratory and Transfusion Medicine, University Hospital Regensburg, Regensburg, Germany
| | - Philipp Y Herzberg
- Department of Personality Psychology and Psychological Assessment, Helmut-Schmidt-University/University of the German Federal Armed Forces Hamburg, Hamburg, Germany
| | - Wolfgang Herr
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
| | - Ernst Holler
- Department of Internal Medicine III, Hematology and Oncology, University Hospital Regensburg, Regensburg, Germany
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28
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Priye S, Sathyanarayan J, Shivaprakash S, Reddy D. Perioperative management of patient with Bombay blood group undergoing mitral valve replacement. Indian J Anaesth 2016; 59:811-3. [PMID: 26903676 PMCID: PMC4743306 DOI: 10.4103/0019-5049.171577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Bombay red blood cell phenotype is an extremely rare blood type for which patients can receive only autologous or Bombay phenotype red blood cells. We report a case of stenotic mitral valve with Bombay phenotype who underwent minimal invasive right lateral thoracotomy for the replacement of the mitral valve. A male patient from Bangladesh presented to the hospital with New York Heart Association III symptoms. His medical evaluation revealed severe mitral valve stenosis and mild aortic valve regurgitation. The patient received erythropoietin, intravenous iron succinate and folic acid tablets. Autologous blood transfusion was carried out. The mitral valve was replaced with a prosthetic valve successfully. After weaning off from cardiopulmonary bypass, heparinisation was corrected with protamine. Post-operatively, the patient received autologous red blood cells. The patient recovered after 1-day of inotropic support with adrenaline and milrinone, and diuretics and was discharged on the 5th post-operative day.
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Affiliation(s)
- Shio Priye
- Department of Cardiac Anaesthesiology and Department Cardiothoracic Vascular Surgery, Vydehi Institute of Medical Sciences And Research Centre, Bangalore, India
| | - J Sathyanarayan
- Department of Cardiac Anaesthesiology and Department Cardiothoracic Vascular Surgery, Vydehi Institute of Medical Sciences And Research Centre, Bangalore, India
| | - S Shivaprakash
- Department of Cardiac Anaesthesiology and Department Cardiothoracic Vascular Surgery, Vydehi Institute of Medical Sciences And Research Centre, Bangalore, India
| | - Durgaprasad Reddy
- Department of Cardiac Anaesthesiology and Department Cardiothoracic Vascular Surgery, Vydehi Institute of Medical Sciences And Research Centre, Bangalore, India
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29
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Worel N. ABO-Mismatched Allogeneic Hematopoietic Stem Cell Transplantation. Transfus Med Hemother 2015; 43:3-12. [PMID: 27022317 DOI: 10.1159/000441507] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/06/2015] [Indexed: 12/19/2022] Open
Abstract
Allogeneic hematopoietic stem cell transplantation (HSCT) is a curative option for a variety of malignant and non-malignant hematological and congenital diseases. Due to the fact that the human leukocyte antigen system is inherited independently of the blood group system, approximately 40-50% of all HSCTs are performed across the ABO blood group barrier. The expected immune-hematological consequences after transplantation of an ABO-mismatched stem cell graft are immediate and delayed hemolytic complications due to presence of isohemagglutinins or passenger lymphocyte syndrome. The risks of these complications can partially be prevented by graft manipulation and appropriate transfusion support. Dependent on the kind of ABO mismatch, different effects on engraftment have been observed, e.g. delayed red blood cell recovery and pure red cell aplasia. Data on incidence of acute graft-versus-host disease (GVHD), non-relapse mortality, relapse, and overall survival are inconsistent as most studies include limited patient numbers, various graft sources, and different conditioning and GVHD prophylaxis regimens. This makes it difficult to detect a consistent effect of ABO-mismatched transplantation in the literature. However, knowledge of expectable complications and close monitoring of patients helps to detect problems early and to treat patients efficiently, thus reducing the number of fatal or life-threatening events caused by ABO-mismatched HSCT.
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Affiliation(s)
- Nina Worel
- Department for Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria
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30
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Valsami S, Dimitroulis D, Gialeraki A, Chimonidou M, Politou M. Current trends in platelet transfusions practice: The role of ABO-RhD and human leukocyte antigen incompatibility. Asian J Transfus Sci 2015; 9:117-23. [PMID: 26420927 PMCID: PMC4562128 DOI: 10.4103/0973-6247.162684] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Platelet transfusions have contributed to the revolutionary modern treatment of hypoproliferative thrombocytopenia. Despite the long-term application of platelet transfusion in therapeutics, all aspects of their optimal use (i.e., in cases of ABO and/or Rh (D incompatibility) have not been definitively determined yet. We reviewed the available data on transfusion practices and outcome in ABO and RhD incompatibility and platelet refractoriness due to anti-human leukocyte antigen (HLA) antibodies. Transfusion of platelets with major ABO-incompatibility is related to reduced posttransfusion platelet (PLT) count increments, compared to ABO-identical and minor, but still are equally effective in preventing clinical bleeding. ABO-minor incompatible transfusions pose the risk of an acute hemolytic reaction of the recipient that is not always related to high anti-A, B donor titers. ABO-identical PLT transfusion seems to be the most effective and safest therapeutic strategy. Exclusive ABO-identical platelet transfusion policy could be feasible, but alternative approaches could facilitate platelet inventory management. Transfusion of platelets from RhD positive donors to RhD negative patients is considered to be effective and safe though is associated with low rate of anti-D alloimmunization due to contaminating red blood cells. The prevention of D alloimmunization is recommended only for women of childbearing age. HLA alloimmunization is a major cause of platelet refractoriness. Managing patients with refractoriness with cross-matched or HLA-matched platelets is the current practice although data are still lacking for the efficacy of this practice in terms of clinical outcome. Leukoreduction contributes to the reduction of both HLA and anti-D alloimmunization.
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Affiliation(s)
- Serena Valsami
- Department of Blood Transfusion, Aretaieion Hospital, Athens University Medical School, Athens, Greece
| | - Dimitrios Dimitroulis
- Department of Propedeutic Surgery, Laiko Hospital, Athens University Medical School, Athens, Greece
| | - Argyri Gialeraki
- Haematology Laboratory and Blood Bank Department, Attikon Hospital, Athens University Medical School, Athens, Greece
| | - Maria Chimonidou
- Department of Blood Transfusion, Aretaieion Hospital, Athens University Medical School, Athens, Greece
| | - Marianna Politou
- Department of Blood Transfusion, Aretaieion Hospital, Athens University Medical School, Athens, Greece
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Antoninus AA, Widowati W, Wijaya L, Agustina D, Puradisastra S, Sumitro SB, Widodo M, Bachtiar I. Human platelet lysate enhances the proliferation of Wharton's jelly-derived mesenchymal stem cells. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.bgm.2015.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
Blood group antigens represent polymorphic traits inherited among individuals and populations. At present, there are 34 recognized human blood groups and hundreds of individual blood group antigens and alleles. Differences in blood group antigen expression can increase or decrease host susceptibility to many infections. Blood groups can play a direct role in infection by serving as receptors and/or coreceptors for microorganisms, parasites, and viruses. In addition, many blood group antigens facilitate intracellular uptake, signal transduction, or adhesion through the organization of membrane microdomains. Several blood groups can modify the innate immune response to infection. Several distinct phenotypes associated with increased host resistance to malaria are overrepresented in populations living in areas where malaria is endemic, as a result of evolutionary pressures. Microorganisms can also stimulate antibodies against blood group antigens, including ABO, T, and Kell. Finally, there is a symbiotic relationship between blood group expression and maturation of the gastrointestinal microbiome.
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Affiliation(s)
- Laura Cooling
- Department of Pathology, University of Michigan, Ann Arbor, Michigan, USA
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Lehner B, Eichelberger B, Jungbauer C, Panzer S. The Blood Group A Genotype Determines the Level of Expression of the Blood Group A on Platelets But Not the Anti-B Isotiter. Transfus Med Hemother 2015; 42:366-71. [PMID: 26733767 DOI: 10.1159/000432414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 01/23/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The extent of expression of the blood group A on platelets is controversial. Further, the relation between platelets' blood group A expression and the titers of isoagglutinins has not been thoroughly investigated, so far. METHODS We evaluated the relation between the genotype with platelets' blood group A and H expression estimated by flow cytometry and the titers of isoagglutinins. RESULTS The A expression varied between genotypes and within genotypes. However, the expression in A1 was stronger than in all other genotypes (p < 0.0001). An overlap of expression levels was apparent between homozygous A1A1 and heterozygous A1 individuals. Still, The A1A1 genotype is associated with a particularly high antigen expression (p = 0.009). Platelets' A expression in A2 versus blood group O donors was also significant (p = 0.007), but there was again an overlap of expression. The secretor status had only little influence on the expression (p = 0.18). Also, isoagglutinin titers were not associated with genotypes. CONCLUSION To distinguish between A1 and A2 donors may reduce incompatible platelet transfusions and therefore be favorable on platelet transfusion increment. Clinical data are needed to support this notion.
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Affiliation(s)
- Barbara Lehner
- Department of Blood Group Serology and Transfusion Medicine, Medical University Vienna, Vienna, Austria
| | - Beate Eichelberger
- Department of Blood Group Serology and Transfusion Medicine, Medical University Vienna, Vienna, Austria
| | | | - Simon Panzer
- Department of Blood Group Serology and Transfusion Medicine, Medical University Vienna, Vienna, Austria
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Zhong M, Zhang H, Reilly JP, Chrisitie JD, Ishihara M, Kumagai T, Azadi P, Reilly MP. ABO Blood Group as a Model for Platelet Glycan Modification in Arterial Thrombosis. Arterioscler Thromb Vasc Biol 2015; 35:1570-8. [PMID: 26044584 DOI: 10.1161/atvbaha.115.305337] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Accepted: 05/22/2015] [Indexed: 01/02/2023]
Abstract
ABO blood groups have long been associated with cardiovascular disease, thrombosis, and acute coronary syndromes. Many studies over the years have shown type O blood group to be associated with lower risk of cardiovascular disease than non-type O blood groups. However, the mechanisms underlying this association remain unclear. Although ABO blood group is associated with variations in concentrations of circulating von Willebrand Factor and other endothelial cell adhesion molecules, ABO antigens are also present on several platelet surface glycoproteins and glycosphingolipids. As we highlight in this platelet-centric review, these glycomic modifications may affect platelet function in arterial thrombosis. More broadly, improving our understanding of the role of platelet glycan modifications in acute coronary syndromes may inform future diagnostics and therapeutics for cardiovascular diseases.
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Affiliation(s)
- Ming Zhong
- From the Cardiology Division, Department of Medicine, Cardiovascular Institute (M.Z., H.Z., M.P.R.) and Pulmonology, Allergy, and Critical Care Division, Department of Medicine (J.P.R., J.D.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Complex Carbohydrate Research Center, University of Georgia, Athens (M.I., T.K., P.A.)
| | - Hanrui Zhang
- From the Cardiology Division, Department of Medicine, Cardiovascular Institute (M.Z., H.Z., M.P.R.) and Pulmonology, Allergy, and Critical Care Division, Department of Medicine (J.P.R., J.D.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Complex Carbohydrate Research Center, University of Georgia, Athens (M.I., T.K., P.A.)
| | - John P Reilly
- From the Cardiology Division, Department of Medicine, Cardiovascular Institute (M.Z., H.Z., M.P.R.) and Pulmonology, Allergy, and Critical Care Division, Department of Medicine (J.P.R., J.D.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Complex Carbohydrate Research Center, University of Georgia, Athens (M.I., T.K., P.A.)
| | - Jason D Chrisitie
- From the Cardiology Division, Department of Medicine, Cardiovascular Institute (M.Z., H.Z., M.P.R.) and Pulmonology, Allergy, and Critical Care Division, Department of Medicine (J.P.R., J.D.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Complex Carbohydrate Research Center, University of Georgia, Athens (M.I., T.K., P.A.)
| | - Mayumi Ishihara
- From the Cardiology Division, Department of Medicine, Cardiovascular Institute (M.Z., H.Z., M.P.R.) and Pulmonology, Allergy, and Critical Care Division, Department of Medicine (J.P.R., J.D.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Complex Carbohydrate Research Center, University of Georgia, Athens (M.I., T.K., P.A.)
| | - Tadahiro Kumagai
- From the Cardiology Division, Department of Medicine, Cardiovascular Institute (M.Z., H.Z., M.P.R.) and Pulmonology, Allergy, and Critical Care Division, Department of Medicine (J.P.R., J.D.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Complex Carbohydrate Research Center, University of Georgia, Athens (M.I., T.K., P.A.)
| | - Parastoo Azadi
- From the Cardiology Division, Department of Medicine, Cardiovascular Institute (M.Z., H.Z., M.P.R.) and Pulmonology, Allergy, and Critical Care Division, Department of Medicine (J.P.R., J.D.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Complex Carbohydrate Research Center, University of Georgia, Athens (M.I., T.K., P.A.)
| | - Muredach P Reilly
- From the Cardiology Division, Department of Medicine, Cardiovascular Institute (M.Z., H.Z., M.P.R.) and Pulmonology, Allergy, and Critical Care Division, Department of Medicine (J.P.R., J.D.C.), Perelman School of Medicine, University of Pennsylvania, Philadelphia; and Complex Carbohydrate Research Center, University of Georgia, Athens (M.I., T.K., P.A.).
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Transfusion of ABO non-identical platelets does not influence the clinical outcome of patients undergoing autologous haematopoietic stem cell transplantation. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2015; 13:411-6. [PMID: 25761311 DOI: 10.2450/2015.0195-14] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Accepted: 11/11/2014] [Indexed: 11/21/2022]
Abstract
BACKGROUND There are ABO antigens on the surface of platelets, but whether ABO compatible platelets are necessary for transfusions is a matter of ongoing debate. We retrospectively reviewed the ABO matching of platelet transfusions in a subset of patients undergoing autologous haematopoietic progenitor cell transplantation during a 14-year period. Our aim was to analyse the characteristics and outcomes of patients who received platelet transfusions that were or were not ABO identical. MATERIAL AND METHODS We analysed 529 consecutive patients with various haematological and non-haematological diseases who underwent 553 autologous progenitor stem cell transplants at the University Hospital la Fe between January 2000 and December 2013. We retrospectively analysed and compared transfusion and clinical outcomes of patients according to the ABO match of the platelet transfusions received. The period analysed was the time from transplantation until discharge. RESULTS The patients received a total of 2,772 platelet concentrates, of which 2,053 (74.0%) were ABO identical and 719 (26.0%) ABO non-identical; of these latter 309 were compatible and 410 incompatible with the patients' plasma. Considering all transplants, 36 (6.5%) did not require any platelet transfusions, while in 246 (44.5%) cases, the patients were exclusively transfused with ABO identical platelets and in 47 (8.5%) cases they received only ABO non-identical platelet transfusions. The group of patients who received both ABO identical and ABO non-identical platelet transfusions had higher transfusion needs and worse clinical outcomes compared to patients who received only ABO identical or ABO non-identical platelets. DISCUSSION In our hospital, patients undergoing autologous haematopoietic stem cell transplantation who received ABO identical or ABO non-identical platelet transfusions had similar transfusion and clinical outcomes. The isolated fact of receiving ABO non-identical platelets did not influence morbidity or survival.
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36
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Nahirniak S, Slichter SJ, Tanael S, Rebulla P, Pavenski K, Vassallo R, Fung M, Duquesnoy R, Saw CL, Stanworth S, Tinmouth A, Hume H, Ponnampalam A, Moltzan C, Berry B, Shehata N. Guidance on Platelet Transfusion for Patients With Hypoproliferative Thrombocytopenia. Transfus Med Rev 2015; 29:3-13. [DOI: 10.1016/j.tmrv.2014.11.004] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 11/17/2014] [Accepted: 11/20/2014] [Indexed: 01/19/2023]
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37
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Cid J, Harm SK, Yazer MH. Platelet transfusion - the art and science of compromise. Transfus Med Hemother 2013; 40:160-71. [PMID: 23922541 PMCID: PMC3725020 DOI: 10.1159/000351230] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Accepted: 02/26/2013] [Indexed: 11/19/2022] Open
Abstract
SUMMARY Many modern therapies depend on platelet (PLT) transfusion support. PLTs have a 4- to 7-day shelf life and are frequently in short supply. In order to optimize the inventory PLTs are often transfused to adults without regard for ABO compatibility. Hemolytic reactions are infrequent despite the presence of 'high titer' anti-A and anti-B antibodies in some of the units. Despite the low risk for hemolysis, some centers provide only ABO identical PLTs to their recipients; this practice might have other beneficial outcomes that remain to be proven. Strategies to mitigate the risk of hemolysis and the clinical and laboratory outcomes following ABO-matched and mismatched transfusions will be discussed. Although the PLTs themselves do not carry the D antigen, a small number of RBCs are also transfused with every PLT dose. The quantity of RBCs varies by the type of PLT preparation, and even a small quantity of D+ RBCs can alloimmunize a susceptible D- host. Thus PLT units are labeled as D+/-, and most transfusion services try to prevent the transfusion of D+ PLTs to D- females of childbearing age. A similar policy for patients with hematological diseases is controversial, and the elements and mechanisms of anti-D alloimmunization will be discussed.
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Affiliation(s)
- Joan Cid
- Apheresis Unit, Department of Hemotherapy-Hemostasis, CDB, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Sarah K. Harm
- Department of Pathology, University of Pittsburgh, PA, USA
| | - Mark H. Yazer
- Department of Pathology, University of Pittsburgh, PA, USA
- The Institute for Transfusion Medicine, Pittsburgh, PA, USA
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38
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39
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Platelet Transfusion Medicine. Platelets 2013. [DOI: 10.1016/b978-0-12-387837-3.00062-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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40
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Flegel WA. ABO genotyping: the quest for clinical applications. BLOOD TRANSFUSION = TRASFUSIONE DEL SANGUE 2013; 11:6-9. [PMID: 23245718 PMCID: PMC3557469 DOI: 10.2450/2012.0250-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 11/14/2012] [Indexed: 11/21/2022]
Affiliation(s)
- Willy A. Flegel
- Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, United States of America
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41
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DeLelys ME, Ochoa G, Cserti-Gazdewich CM, Vietz C, Preffer FI, Dzik W. Relationship betweenABOgenotype and A antigen expression on platelets. Transfusion 2012; 53:1763-71. [DOI: 10.1111/j.1537-2995.2012.03952.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 09/12/2012] [Accepted: 09/19/2012] [Indexed: 02/04/2023]
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42
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ABO Blood Groups and Cardiovascular Diseases. Int J Vasc Med 2012; 2012:641917. [PMID: 23133757 PMCID: PMC3485501 DOI: 10.1155/2012/641917] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 08/25/2012] [Accepted: 09/01/2012] [Indexed: 01/02/2023] Open
Abstract
ABO blood groups have been associated with various disease phenotypes, particularly cardiovascular diseases. Cardiovascular diseases are the most common causes of death in developed countries and their prevalence rate is rapidly growing in developing countries. There have been substantial historical associations between non-O blood group status and an increase in some cardiovascular disorders. Recent GWASs have identified ABO as a locus for thrombosis, myocardial infarction, and multiple cardiovascular risk biomarkers, refocusing attention on mechanisms and potential for clinical advances. As we highlight in this paper, more recent work is beginning to probe the molecular basis of the disease associations observed in these observational studies. Advances in our understanding of the physiologic importance of various endothelial and platelet-derived circulating glycoproteins are elucidating the mechanisms through which the ABO blood group may determine overall cardiovascular disease risk. The role of blood group antigens in the pathogenesis of various cardiovascular disorders remains a fascinating subject with potential to lead to novel therapeutics and prognostics and to reduce the global burden of cardiovascular diseases.
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43
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Garraud O, Hamzeh-Cognasse H, Cognasse F. Platelets and cytokines: How and why? Transfus Clin Biol 2012; 19:104-8. [PMID: 22682309 DOI: 10.1016/j.tracli.2012.02.004] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 02/29/2012] [Indexed: 12/11/2022]
Abstract
For patients with platelet deficiencies, platelet components are therapeutic products for which there is no substitute. However, transfusion complications are more frequent with this labile blood product than with others. This is attributable to products secreted by the platelets themselves, including a variety of cytokines, chemokines, and biological response modifiers, some of which are secreted in large quantities following platelet activation. Why platelets are activated and prone to releasing these molecules during certain inflammatory and innate immune responses is not yet fully understood, but it could be due to several parameters including incompatibilities between blood donors and recipients, the process of platelet preparation and preservation, and the ability of the donor's immune system to sense danger presented by external stimuli during the blood donation process. This review presents our current knowledge of how the platelets that constitute the platelet component for transfusion are sources of cytokines and biological response modifiers and discusses methods to improve the quality of blood transfusion products and safety for patients.
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Affiliation(s)
- O Garraud
- Établissement français du sang Auvergne-Loire, 25, boulevard Pasteur, 42023 Saint-Étienne cedex 02, France.
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The impact of platelet transfusion characteristics on posttransfusion platelet increments and clinical bleeding in patients with hypoproliferative thrombocytopenia. Blood 2012; 119:5553-62. [PMID: 22496156 DOI: 10.1182/blood-2011-11-393165] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Platelet characteristics, such as platelet dose, platelet source (apheresis vs pooled), platelet donor-recipient ABO compatibility, and duration of platelet storage, can affect posttransfusion platelet increments, but it is unclear whether these factors impact platelet transfusion efficacy on clinical bleeding. We performed secondary analyses of platelet transfusions given in the prospective randomized Platelet Dose Study, which included 1272 platelet-transfused hematology-oncology patients who received 6031 prophylactic platelet transfusions. The primary outcome of these analyses was time from first transfusion to first World Health Organization ≥ grade 2 bleeding. Platelet transfusion increments were assessed at 0.25 to 4 hours and 16 to 32 hours after platelet transfusion. There were 778 patients evaluable for analysis of time to bleeding. Adjusted models showed that randomized dose strategy, platelet source, ABO compatibility, and duration of storage did not predict this outcome. Platelet increments were generally higher for transfusions of apheresis platelets, ABO-identical platelets, and platelets stored 3 days versus 4 to 5 days. Thus, although platelet source, ABO compatibility, and duration of storage exert a modest impact on both absolute and corrected posttransfusion platelet increments, they have no measurable impact on prevention of clinical bleeding. This trial was registered at www.clinicaltrials.gov as #NCT00128713.
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45
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Alternative blood products and clinical needs in transfusion medicine. Stem Cells Int 2012; 2012:639561. [PMID: 22567025 PMCID: PMC3337502 DOI: 10.1155/2012/639561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2011] [Accepted: 12/30/2011] [Indexed: 01/19/2023] Open
Abstract
The primary focus of national blood programs is the provision of a safe and adequate blood supply. This goal is dependent on regular voluntary donations and a regulatory infrastructure that establishes and enforces standards for blood safety. Progress in ex vivo expansion of blood cells from cell sources including peripheral blood, cord blood, induced pluripotent stem cells, and human embryonic stem cell lines will likely make alternative transfusion products available for clinical use in the near future. Initially, alloimmunized patients and individuals with rare blood types are most likely to benefit from alternative products. However, in developed nations voluntary blood donations are projected to be inadequate in the future as blood usage by individuals 60 years and older increases. In developing nations economic and political challenges may impede progress in attaining self-sufficiency. Under these circumstances, ex vivo generated red cells may be needed to supplement the general blood supply.
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46
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O'Donghaile D, Kelley W, Klein HG, Flegel WA. Recommendations for transfusion in ABO-incompatible hematopoietic stem cell transplantation. Transfusion 2012; 52:456-8. [PMID: 22239215 DOI: 10.1111/j.1537-2995.2011.03465.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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47
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Henrichs KF, Howk N, Masel DS, Thayer M, Refaai MA, Kirkley SA, Heal JM, Blumberg N. Providing ABO-identical platelets and cryoprecipitate to (almost) all patients: approach, logistics, and associated decreases in transfusion reaction and red blood cell alloimmunization incidence. Transfusion 2012; 52:635-40. [PMID: 21895675 PMCID: PMC3235249 DOI: 10.1111/j.1537-2995.2011.03329.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are multiple benefits to transfusing only ABO-identical blood components. Historically our institution routinely transfused ABO-nonidentical platelets (PLTs) and cryoprecipitate to surgical patients. In April 2005, we implemented a policy of transfusing only ABO-identical components whenever feasible, regardless of outdating or logistic considerations. STUDY DESIGN AND METHODS Technical staff closely monitored product usage and adjusted blood center orders based on recent utilization and planned transfusions. When unable to provide ABO-identical PLTs, ABO-compatible PLTs were washed to remove incompatible plasma. Data on outdating were collected for 18 months before and after implementation. We compared transfusion reaction and red blood cell (RBC) alloimmunization incidence for 4 years preceding (2001-2004) and subsequent (2006-2009) to implementation. RESULTS In the year after implementation, only 11 of 410 surgical patients received ABO-nonidentical PLTs (2.7%). There was a 5.6% increase in outdating of PLTs. Transfusing ABO-identical components was associated with significant reductions in febrile (-46%; 8.0 to 4.3 per 10,000 components; p < 0.0001) and allergic transfusion reactions (-23%; from 7.0 to 5.4 per 10,000 components; p = 0.025). A progressive reduction in de novo RBC alloimmunization incidence also occurred (-50% by 2009; p = 0.03). CONCLUSIONS Providing ABO-identical PLTs to almost all patients was feasible in our setting by changing ordering and inventorying procedures and making the ABO-identical policy a staff priority. Unexpected and striking reductions in febrile and allergic reactions and RBC alloimmunization were observed, of uncertain causal relationship to this ABO policy change, which will require further study.
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Affiliation(s)
- Kelly F Henrichs
- Department of Pathology and Laboratory Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York 14642, USA
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48
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Lucidi CDA, Takahira RK, Gerlach JA, Davis JM, Schwartz KA, Scott MA. Flow cytometric assessment of canine erythrocytes and platelets for dog erythrocyte antigen 1.1. Vet Clin Pathol 2011; 40:435-443. [DOI: 10.1111/j.1939-165x.2011.00374.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Cynthia de A. Lucidi
- Department of Veterinary Clinics; School of Veterinary Medicine and Animal Sciences; São Paulo State University-Unesp; Botucatu São Paulo Brazil
| | - Regina K. Takahira
- Department of Veterinary Clinics; School of Veterinary Medicine and Animal Sciences; São Paulo State University-Unesp; Botucatu São Paulo Brazil
| | - John A. Gerlach
- Biomedical Laboratory Diagnostics Program; College of Natural Science and Department of Medicine; College of Human Medicine and
| | | | | | - Michael A. Scott
- Pathobiology and Diagnostic Investigation; College of Veterinary Medicine; Michigan State University; East Lansing MI USA
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The development of severe neonatal alloimmune thrombocytopenia due to anti-HPA-1a antibodies is correlated to maternal ABO genotypes. Clin Dev Immunol 2011; 2012:156867. [PMID: 22110529 PMCID: PMC3216343 DOI: 10.1155/2012/156867] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2011] [Revised: 08/16/2011] [Accepted: 09/16/2011] [Indexed: 11/17/2022]
Abstract
Background. Maternal alloantibodies against HPA-1a can cross placenta, opsonize foetal platelets, and induce neonatal alloimmune thrombocytopenia (NAIT). In a study of 100, 448 pregnant women in Norway during 1995–2004, 10.6% of HPA-1a negative women had detectable anti-HPA-1a antibodies. Design and Methods. A possible correlation between the maternal ABO blood group phenotype, or underlying genotype, and severe thrombocytopenia in the newborn was investigated. Results. We observed that immunized women with blood group O had a lower risk of having a child with severe NAIT than women with group A; 20% with blood group O gave birth to children with severe NAIT, compared to 47% among the blood group A mothers (relative risk 0.43; 95% CI 0.25–0.75). Conclusion. The risk of severe neonatal alloimmune thrombocytopenia due to anti-HPA-1a antibodies is correlated to maternal ABO types, and this study indicates that the observation is due to genetic properties on the maternal side.
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50
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Rowley SD, Donato ML, Bhattacharyya P. Red blood cell-incompatible allogeneic hematopoietic progenitor cell transplantation. Bone Marrow Transplant 2011; 46:1167-85. [DOI: 10.1038/bmt.2011.135] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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