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Aggarwal A. Evidence Cornered: Transfusion Evidence Summary - Platelet transfusion before CVC placement in patients with thrombocytopenia (PACER trial). Transfus Med 2024; 34:172-174. [PMID: 38632111 DOI: 10.1111/tme.13040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 01/26/2024] [Accepted: 03/19/2024] [Indexed: 04/19/2024]
Affiliation(s)
- Asha Aggarwal
- NHS Blood and Transplant, Oxford University Hospitals, Oxford, UK
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Berenger JB, Saillard C, Sannini A, Servan L, Gonzalez F, Faucher M, de Guibert JM, Hospital MA, Bisbal M, Chow-Chine L, Mokart D. Prophylactic versus restrictive platelet transfusion strategy in patients with haematological malignancies in the ICU setting, a propensity-score analysis. J Crit Care 2024; 83:154817. [PMID: 38805833 DOI: 10.1016/j.jcrc.2024.154817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/20/2024] [Accepted: 04/25/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE Prophylactic platelet transfusions (PT) aim to reduce bleeding. We assessed whether restrictive PT compared to prophylactic strategy could apply in ICU. MATERIAL AND METHODS We conducted a retrospective monocentric study including patients >18 yo with haematological malignancy admitted to the ICU with thrombocytopenia <20 G/L between 2018 and 2021. Patients were classified in 2 groups according transfusion strategy applied during the first 3 days: prophylactic or restrictive transfusion. RESULTS 180 patients were included, 87 and 93 in the restrictive and prophylactic groups respectively. After propensity-score analysis, 2 groups of 54 matched patients were analyzed. Restrictive strategy led to a significant reduction in PT with incidence rate for 100-ICU-patients-days of 34.9 and 49.9, incidence rate ratio = 0.699 [0.5-0.9], p = 0.006, representing a 31% decrease. Decreased PT persisted until day 28 with platelet concentrates transfusions-free days at day 28 of 21 [13-25] and 16.5 [10.2-21] in the 2 groups (p = 0.04). Restrictive strategy did not result in higher grade ≥ 2 bleeding. Transfusion efficiency was low with similar number of days with platelet <10 or < 20 G/L regardless of strategy. Platelet transfusion strategy was not associated with 28-day mortality. Platelet nadir <5G/L was associated with day-28 mortality with HR = 1.882 [1.011-3.055], p = 0.046. CONCLUSION A restrictive PT strategy appears feasible in the ICU.
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Affiliation(s)
- Jean-Baptiste Berenger
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France
| | - Colombe Saillard
- Haematology Department, Institut Paoli Calmettes, Marseille, France
| | - Antoine Sannini
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France
| | - Luca Servan
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France
| | - Frederic Gonzalez
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France
| | - Marion Faucher
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France
| | - Jean-Manuel de Guibert
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France
| | | | - Magali Bisbal
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France
| | - Laurent Chow-Chine
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France
| | - Djamel Mokart
- Polyvalent Intensive Care Unit, Department of Anesthesiology and Critical Care, Institut Paoli Calmettes, Marseille, France.
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Park N, Correa Medina M, Martinez F, Throssel M, Dasgupta A, Knopfelmacher A, Villamin C, Rivas S, Tomczak N, Garg S, Layton L, Klein K. Trend towards reduction of transfusion reactions using prestorage leukocyte-reduced and pooled whole blood-derived platelets and cost savings compared with poststorage whole blood-derived random platelets as evidenced by real-time hemovigilance. Lab Med 2024; 55:251-254. [PMID: 38175635 DOI: 10.1093/labmed/lmad106] [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] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Due to chemotherapy-induced neutropenia or hematologic malignancies, immunocompromised cancer patients may have higher incidence of febrile nonhemolytic transfusion reactions compared with the general population and frequently require platelet transfusions. This quality improvement project compared the safety of transfusion using prestorage leukocyte-reduced and pooled whole blood-derived platelets (Acrodose/WBD) with conventionally produced poststorage WBD platelets (RDP) using an active hemovigilance system. METHODS Every patient receiving a blood product at the hospital was virtually monitored in real time by trained nurses from a remote hemovigilance unit. These nurses monitor a digital dashboard, which populates a watch list of patients from the time blood product administration is initiated until 12 hours posttransfusion. Over the course of 6 months, 371 patients receiving 792 RDP transfusions and 423 patients receiving 780 Acrodose/WBD platelets transfusions were monitored for transfusion reactions. RESULTS We identified 26 transfusion reactions in RDP but only 12 transfusion reactions in the Acrodose/WBD platelet group. CONCLUSION Acrodose platelet transfusion was associated with fewer transfusion reactions, which resulted in significant cost savings.
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Affiliation(s)
- Nick Park
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Mayrin Correa Medina
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Fernando Martinez
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Marla Throssel
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Amitava Dasgupta
- Department of Pathology and Laboratory Medicine University of Kansas Medical Center, Kansas City, KS, US
| | - Adriana Knopfelmacher
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Colleen Villamin
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Sandra Rivas
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Nancy Tomczak
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Saahith Garg
- Department of Biochemistry, University of Texas Health Science Center at Houston, Houston, TX, US
| | - Lorraine Layton
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
| | - Kimberly Klein
- Department of Laboratory Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, US
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4
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Taki S, Ida Y, Tamai H, Maeshima S, Shimizu R, Shingaki N, Maekita T, Iguchi M, Kitano M. Lusutrombopag Reduces the Risk of Hemoperitoneum Caused by Percutaneous Radiofrequency Ablation for Hepatocellular Carcinoma Compared with Platelet Transfusion. Dig Dis 2024:1-7. [PMID: 38663358 DOI: 10.1159/000539006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 04/04/2024] [Indexed: 06/14/2024]
Abstract
INTRODUCTION Patients with liver cirrhosis develop thrombocytopenia and an increased risk of bleeding events after invasive procedures. Lusutrombopag, a thrombopoietin receptor agonist, can increase the platelet count. This study assessed whether lusutrombopag reduces the risk of hemoperitoneum following percutaneous radiofrequency ablation for hepatocellular carcinoma, compared with platelet transfusion. METHODS Participants in the present study comprised patients with severe thrombocytopenia (platelet count <50,000/μL) enrolled between November 2012 and March 2020, excluding patients with idiopathic thrombocytopenia or anticoagulant use. Hemoperitoneum rate, hemostasis rate, hemoglobin reduction rate, rate of achieving a platelet count ≥50,000/μL, and increases in platelet count and factors contributing to hemoperitoneum were retrospectively analyzed. RESULTS This study enrolled 41 patients, comprising 18 patients administered lusutrombopag and 23 patients who received platelet transfusion. The major hemoperitoneum rate after RFA was tend to be lower in the lusutrombopag group (0%) than in the platelet transfusion group (21.7%). All of the major hemoperitoneum was observed in the platelet transfusion group. Hemoglobin reduction rate was lower in the lusutrombopag group (-0.17%) than in the platelet transfusion group (6.79%, p = 0.013). Hemostasis rate was lower in the lusutrombopag group (0%) than in the platelet transfusion group (21.7%, p = 0.045). The rate of achievement of platelet counts ≥50,000/μL the day after RFA was higher in the lusutrombopag group (100%) than in the platelet transfusion group (60.9%, p = 0.005). CONCLUSION Lusutrombopag may be able to perform RFA more safely with respect to the hemoperitoneum caused by percutaneous radiofrequency ablation compared with platelet transfusion.
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Affiliation(s)
- Shinya Taki
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan,
| | - Yoshiyuki Ida
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hideyuki Tamai
- Department of Hepatology, Wakayama Rosai Hospital, Wakayama, Japan
| | - Shuya Maeshima
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Ryo Shimizu
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Naoki Shingaki
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takao Maekita
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Mikitaka Iguchi
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masayuki Kitano
- Second Department of Internal Medicine, Wakayama Medical University, Wakayama, Japan
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Wang Y, Zhang W, Rao Q, Ma Y, Ding X, Zhang X, Li X. Forecasting demands of blood components based on prediction models. Transfus Clin Biol 2024:S1246-7820(24)00059-4. [PMID: 38670448 DOI: 10.1016/j.tracli.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/07/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND An adequate blood supply is an important guarantee for saving lives and protecting health. In order to manage the blood supply more effectively when the condition of demand and supply are uncertainty, it is very important to forecast the demands of blood resources. MATERIALS AND METHODS SARIMAX model and LSTM model were integrated into the prediction system of blood station. The collection and supply data of blood components was directly imported into the forecasting models to achieve automatic data update and model update. The forecasting daily demands of apheresis platelets, washing red blood cells (RBCs), suspended RBCs and plasma were recorded from January to June 2023 and compared with real data. RESULTS The prediction models had good forecasting performances. In the goodness of fit results of apheresis platelet model, the maximum value of coefficient of determination (R2) could reach 87.6%, and the minimum value of the mean absolute percentage error (MAPE) was only 0.0037. The predicted data of washing RBCs could be basically fitted, and the MAPE was 0.0121. For the prediction of suspended RBCs, the R2 was greater than 66%, and the MAPE could be 0.0372. The plasma model generated very high goodness of fit results, with R2 of over 90% and the lowest MAPE of 0.0394. CONCLUSION The forecasting models, which predicts future demands of different blood components based on historical data, can help managers to overcome the challenges of blood stock control more effectively, thereby reducing blood waste and blood shortages.
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Affiliation(s)
- Yajie Wang
- Department of Blood Transfusion, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Wei Zhang
- Beijing Tongzhou Central Blood Station, Beijing 101100, China
| | - Quan Rao
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Yiming Ma
- Department of Blood Transfusion, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - Xinyi Ding
- The Information Department, Beijing University Of Technology, No. 100, Pingleyuan, Chaoyang District, Beijing 100124, China
| | - Xiao Zhang
- The Information Department, Beijing University Of Technology, No. 100, Pingleyuan, Chaoyang District, Beijing 100124, China.
| | - Xiaofei Li
- Department of Blood Transfusion, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China.
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6
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Chen M, Li L, Xia Q, Chen X, Liao Z, Wang C, Shen B, Zhou M, Zhang Q, Zhang Y, Qian L, Yuan X, Wang Z, Xue C, An X, Liu B, Gu K, Hou M, Wang X, Wang W, Li E, Zhong J, Cheng J, Shu Y, Yang N, Wang H, Yang R, Liu T, Deng T, Ma F, Liao W, Qiu W, Chen Y, Chen X, Zhang M, Xu R, Li X, Feng J, Ba Y, Shi Y. A real-world observation on thrombopoietic agents for patients with cancer treatment-induced thrombocytopenia in China: A multicenter, cross-sectional study. Cancer 2024; 130:1524-1538. [PMID: 38515388 DOI: 10.1002/cncr.35292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/12/2023] [Accepted: 01/08/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Studies on various thrombopoietic agents for cancer treatment-induced thrombocytopenia (CTIT) in China are lacking. This study aimed to provide detailed clinical profiles to understand the outcomes and safety of different CTIT treatment regimens. METHODS In this retrospective, cross-sectional study, 1664 questionnaires were collected from 33 hospitals between March 1 and July 1, 2021. Patients aged >18 years were enrolled who were diagnosed with CTIT and treated with recombinant interleukin 11 (rhIL-11), recombinant thrombopoietin (rhTPO), or a thrombopoietin receptor agonist (TPO-RA). The outcomes, compliance, and safety of different treatments were analyzed. RESULTS Among the 1437 analyzable cases, most patients were treated with either rhTPO alone (49.3%) or rhIL-11 alone (27.0%). The most common combination regimen used was rhTPO and rhIL-11 (10.9%). Platelet transfusions were received by 117 cases (8.1%). In multivariate analysis, rhTPO was associated with a significantly lower proportion of platelet recovery, platelet transfusion, and hospitalization due to chemotherapy-induced thrombocytopenia (CIT) than rhIL-11 alone. No significant difference was observed in the time taken to achieve a platelet count of >100 × 109/L and chemotherapy dose reduction due to CIT among the different thrombopoietic agents. The outcomes of thrombocytopenia in 170 patients who received targeted therapy and/or immunotherapy are also summarized. The results show that the proportion of platelet recovery was similar among the different thrombopoietic agents. No new safety signals related to thrombopoietic agents were observed in this study. A higher proportion of physicians preferred to continue treatment with TPO-RA alone than with rhTPO and rhIL-11. CONCLUSIONS This survey provides an overview of CTIT and the application of various thrombopoietic agents throughout China. Comparison of monotherapy with rhIL-11, rhTPO, and TPO-RA requires further randomized clinical trials. The appropriate application for thrombopoietic agents should depend on the pretreatment of platelets, treatment variables, and risk of bleeding. PLAIN LANGUAGE SUMMARY To provide an overview of the outcome of cancer treatment-induced thrombocytopenia in China, our cross-sectional study analyzed 1437 cases treated with different thrombopoietic agents. Most of the patients were treated with recombinant interleukin 11 (rhIL-11) and recombinant thrombopoietin (rhTPO). rhTPO was associated with a significantly lower proportion of platelet recovery and platelet transfusion compared with rhIL-11.
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Affiliation(s)
- Meiting Chen
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Lu Li
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Qing Xia
- Department of Oncology, Renji Hospital, Medical College of Shanghai Jiaotong University, Shanghai, China
| | - Xiaobing Chen
- Departement of Oncology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, China
| | - Zijun Liao
- Departement of Medical Oncology, Shaanxi Cancer Hospital, Xi'an, China
| | - Chang Wang
- Department of Cancer Center, First Hospital of Jilin University, Changchun, China
| | - Bo Shen
- Department of Oncology, Jiangsu Cancer Institute, Nanjing, China
| | - Min Zhou
- Internal Medicine, Affiliated Cancer Hospital and Institute of Guangzhou Medical University, Guangzhou, China
| | - Qingyuan Zhang
- Department of Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Yanqiao Zhang
- Department of Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Liting Qian
- Division of Life Sciences and Medicine, Department of Radiation Oncology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China
| | - Xianglin Yuan
- Department of Oncology, Cancer Center of Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Zhehai Wang
- Department of Respiratory Medicine, Shandong Cancer Hospital and Institute, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China
| | - Cong Xue
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xin An
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Bin Liu
- Internal Medicine, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Kangsheng Gu
- Department of Oncology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mei Hou
- Lung Cancer Center, West China Hospital of Sichuan University, Chengdu, China
| | - Xiaojia Wang
- Department of Breast Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Wei Wang
- Internal Medicine, First People's Hospital of Foshan, Foshan, China
| | - Enxiao Li
- Department of Medical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University Medical College, Xi'an, China
| | - Jincai Zhong
- The First Affiliated Hospital of Guangxi Medicine University, Nanning, China
| | - Jing Cheng
- Cancer Center of Union Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yongqian Shu
- Department of Oncology, Jiangsu Province Hospital, Nanjing Medical University, Nanjing, China
| | - Nong Yang
- Department of Pharmacy, Hunan Cancer Hospital, Changsha, China
| | - Huaqing Wang
- Department of Medical Oncology, Tianjin People's Hospital, Tianjin, China
| | - Runxiang Yang
- Department of Oncology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical College, Kunming, China
| | - Tianshu Liu
- Department of Medical Oncology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ting Deng
- Department of Gastrointestinal Medical Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Clinical Research Center for Cancer, Tianjin, China
| | - Fei Ma
- Internal Medicine, Cancer Hospital of the Chinese Academy of Medical Sciences, Beijing, China
| | - Wangjun Liao
- Internal Medicine-Oncology, Southern Medical University Nanfang Hospital, Guangzhou, China
| | - Wensheng Qiu
- The Second Department of Oncology, Affiliated Hospital of Qingdao University, Qingdao, China
| | - Yu Chen
- Department of Oncology, Fujian Provincial Cancer Hospital, Fuzhou, China
| | - Xi Chen
- Department of Medical Oncology, Fuzhou General Hospital of Nanjing Military Command, Fuzhou, China
| | - Mingzhi Zhang
- Department of Oncology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruilian Xu
- Department of Medical Oncology, Shenzhen People's Hospital, Shenzhen, China
| | - Xiaoling Li
- Department of Thoracic Cancer 1, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Jifeng Feng
- Department of Oncology, Jiangsu Cancer Institute, Nanjing, China
| | - Yi Ba
- Department of Gastrointestinal Medical Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin Clinical Research Center for Cancer, Tianjin, China
| | - Yanxia Shi
- Department of Medical Oncology, State Key Laboratory of Oncology in South China, Sun Yat-sen University Cancer Center, Guangzhou, China
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Crawford J, Herndon D, Gmitter K, Weiss J. The impact of myelosuppression on quality of life of patients treated with chemotherapy. Future Oncol 2024:1-16. [PMID: 38587388 DOI: 10.2217/fon-2023-0513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 02/21/2024] [Indexed: 04/09/2024] Open
Abstract
Side effects from chemotherapy-induced myelosuppression can negatively affect patients' quality of life (QoL). Neutropenia increases infection risk, and anemia frequently results in debilitating fatigue. Additionally, the bleeding risk associated with thrombocytopenia can lead to fear and anxiety. However, traditional interventions for myelosuppression fall short of the ideal. Granulocyte colony-stimulating factors reduce the risk of severe neutropenia but commonly lead to bone pain. Erythropoiesis-stimulating agents are not always effective and may cause thromboembolic events, while transfusions to correct anemia/thrombocytopenia are associated with transfusion reactions and volume overload. Trilaciclib, which is approved for reducing myelosuppression in patients with extensive-stage small cell lung cancer, together with several investigational agents in development for managing myelosuppression have the potential to improve QoL for patients on chemotherapy.
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Affiliation(s)
| | - Dana Herndon
- Cone Health Cancer Center, Greensboro, NC 27403, USA
| | | | - Jared Weiss
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC 27599, USA
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8
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Christison-Lagay ER, Brown EG, Bruny J, Funaro M, Glick RD, Dasgupta R, Grant CN, Engwall-Gill AJ, Lautz TB, Rothstein D, Walther A, Ehrlich PF, Aldrink JH, Rodeberg D, Baertschiger RM. Central Venous Catheter Consideration in Pediatric Oncology: A Systematic Review and Meta-analysis From the American Pediatric Surgical Association Cancer Committee. J Pediatr Surg 2024:S0022-3468(24)00201-X. [PMID: 38637207 DOI: 10.1016/j.jpedsurg.2024.03.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 02/08/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Tunneled central venous catheters (CVCs) are the cornerstone of modern oncologic practice. Establishing best practices for catheter management in children with cancer is essential to optimize care, but few guidelines exist to guide placement and management. OBJECTIVES To address four questions: 1) Does catheter composition influence the incidence of complications; 2) Is there a platelet count below which catheter placement poses an increased risk of complications; 3) Is there an absolute neutrophil count (ANC) below which catheter placement poses an increased risk of complications; and 4) Are there best practices for the management of a central line associated bloodstream infection (CLABSI)? METHODS Data Sources: English language articles in Ovid Medline, PubMed, Embase, Web of Science, and Cochrane Databases. STUDY SELECTION Independently performed by 2 reviewers, disagreements resolved by a third reviewer. DATA EXTRACTION Performed by 4 reviewers on forms designed by consensus, quality assessed by GRADE methodology. RESULTS Data were extracted from 110 manuscripts. There was no significant difference in fracture rate, venous thrombosis, catheter occlusion or infection by catheter composition. Thrombocytopenia with minimum thresholds of 30,000-50,000 platelets/mcl was not associated with major hematoma. Limited evidence suggests a platelet count <30,000/mcL was associated with small increased risk of hematoma. While few studies found a significant increase in CLABSI in CVCs placed in neutropenic patients with ANC<500Kcells/dl, meta-analysis suggests a small increase in this population. Catheter removal remains recommended in complicated or persistent infections. Limited evidence supports antibiotic, ethanol, or hydrochloric lock therapy in definitive catheter salvage. No high-quality data were available to answer any of the proposed questions. CONCLUSIONS Although over 15,000 tunneled catheters are placed annually in North America into children with cancer, there is a paucity of evidence to guide practice, suggesting multiple opportunities to improve care. LEVEL OF EVIDENCE III. This study was registered as PROSPERO 2019 CRD42019124077.
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Affiliation(s)
- Emily R Christison-Lagay
- Department of Surgery, Yale New Haven Children's Hospital, Yale School of Medicine, New Haven, CT, USA
| | - Erin G Brown
- Department of Surgery, University of California Davis Children's Hospital, University of California Davis, Sacramento, CA, USA
| | - Jennifer Bruny
- Alaska Pediatric Surgery, Alaska Regional Hospital, Anchorage, AK, USA
| | - Melissa Funaro
- Harvey Cushing/John Hay Whitney Medical Library, Yale University, New Haven, CT, USA
| | - Richard D Glick
- Department of Surgery, Cohen Children's Medical Center, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, USA
| | - Roshni Dasgupta
- Department of Surgery, Cincinnati Children's Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Christa N Grant
- Department of Surgery, Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | | | - Timothy B Lautz
- Department of Surgery, Ann & Robert H Lurie Children's Hospital of Chicago, Northwestern University, Chicago IL, USA
| | - David Rothstein
- Department of Surgery, Seattle Children's Hospital, University of Washington, Seattle, WA, USA
| | - Ashley Walther
- Department of Surgery, Children's Hospital of Los Angeles, Keck School of Medicine at University of Southern California, Los Angeles, CA, USA
| | - Peter F Ehrlich
- Department of Surgery, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Jennifer H Aldrink
- Division of Pediatric Surgery, Department of Surgery, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH, USA
| | - David Rodeberg
- Department of Surgery, Kentucky Children's Hospital, University of Kentucky, Lexington, KY, USA
| | - Reto M Baertschiger
- Department of Surgery, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada; Division of Pediatirc Surgery, Children's Hospital at Dartmouth, Dartmouth Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebaon, NH, USA.
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9
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Adkins BD, Jacobs JW, Booth GS, Savani BN, Stephens LD. Transfusion Support in Hematopoietic Stem Cell Transplantation: A Contemporary Narrative Review. Clin Hematol Int 2024; 6:128-140. [PMID: 38817704 PMCID: PMC11086996 DOI: 10.46989/001c.94135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/05/2024] [Indexed: 06/01/2024] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is a cornerstone of modern medical practice, and can only be performed safely and effectively with appropriate transfusion medicine support. Patients undergoing HSCT often develop therapy-related cytopenia, necessitating differing blood product requirements in the pre-, peri-, and post-transplant periods. Moreover, ensuring optimal management for patients alloimmunized to human leukocyte antigens (HLA) and/or red blood cell (RBC) antigens, as well as for patients receiving ABO-incompatible transplants, requires close collaboration with transfusion medicine and blood bank professionals. Finally, as updated transfusion guidelines and novel blood product modifications emerge, the options available to the transplant practitioner continue to expand. Herein, we detail contemporary blood transfusion and transfusion medicine practices for patients undergoing HSCT.
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Affiliation(s)
- Brian D. Adkins
- PathologyThe University of Texas Southwestern Medical Center
| | | | - Garrett S. Booth
- Pathology, Microbiology, and ImmunologyVanderbilt University Medical Center
| | - Bipin N. Savani
- Internal Medicine, Division of Hematology/ OncologyVanderbilt University Medical Center
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10
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Jia M, Wang Z, Hu F. Causal relationship between physical activity and platelet traits: a Mendelian randomization study. Front Physiol 2024; 15:1371638. [PMID: 38571721 PMCID: PMC10987957 DOI: 10.3389/fphys.2024.1371638] [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: 01/16/2024] [Accepted: 02/28/2024] [Indexed: 04/05/2024] Open
Abstract
Introduction: The purpose of this study was to discuss the causal relationship between physical activity and platelet traits. Methods: A dataset from a large-scale European physical activity and platelet traits was collected by using Mendelian randomization of the study. For the analysis, the inverse variance weighting method, weighted median and MR-Egger were used to estimate causal effects. The sensitivity analyses were also performed using Cochran's Q test, funnel plots and Leave-one-out analysis. Results: Light DIY, other exercises, strenuous sports, walking for pleasure were significantly associated with a decrease in platelet crit. But none of the heavy /light DIY was associated with increase in platelet crit. Other exercises and strenuous sports were associated with decrease in platelet count. Conclusion: Some types of physical activity have a causal relationship with platelet crit and platelet count. However, the types of physical activity we studied have not supported a causal relationship with mean platelet volume and platelet distribution width.
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Affiliation(s)
| | - Zhiyong Wang
- Department of Physical Education, Dong-A University, Busan, Republic of Korea
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11
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Yuan S, Yang D, Nakamura R, Al Malki MM, Salhotra A, Afkhami M, Wang S. Lack of RBC transfusion independence by Day 30 following allogeneic hematopoietic stem cell transplant strongly predicts inferior survival and high non-relapse mortality in acute myeloid leukemia patients. Transfusion 2024; 64:255-280. [PMID: 38225215 DOI: 10.1111/trf.17714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 11/29/2023] [Accepted: 12/15/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Studies have suggested that acute myeloid leukemia (AML) patients with incomplete hematologic recovery undergoing allogeneic stem cell transplantation (allo-HSCT) had inferior overall survival (OS). STUDY DESIGN AND METHODS This single-center, retrospective study of AML patients evaluated the relationship between red blood cell (RBC) and platelet (PLT) transfusion requirements during the first 30 days and long-term outcomes after allo-HSCT through multivariate analyses. RESULTS A total of 692 AML patients received peripheral blood stem cells (89.2%), marrow (5.6%), or umbilical cord (5.2%) from matched related (37.4%), unrelated (49.1%), or haploidentical (8.2%) donors in 2011-2017. Transfusion requirements during the first 30 days for RBC (89.5% transfused, median 3, range 1-18 units) or PLT (98.2% transfused, median 6, range 1-144 units) were variable. By Day 30, 56.7% (95% confidence interval [CI]: 52.8-60.3%) and 86.1% (95% CI: 83.2-88.5%) had achieved RBC and PLT transfusion independence, respectively. Median follow-up among survivors (n = 307) was 7.1 years (range: 2.7-11.8). Lack of RBC transfusion independence by Day 30 was strongly and independently associated with worse 5-year OS (39.2% vs. 59.6%, adjusted hazard ratio [HR] 1.83, 95% CI: 1.49-2.25), leukemia-free survival (35.8% vs. 55.5%, HR = 1.75, 95% CI: 1.43-2.14), and NRM (29.7% vs. 13.7%, HR = 2.05, 95% CI: 1.45-2.89) (p < .001). There was no difference in relapse rates among patients who achieved or did not achieve RBC (p = .34) or PLT (p = .64) transfusion independence. CONCLUSION Prolonged RBC dependence predicted worse survival and NRM rates, but not increased relapse. Posttransplant surveillance of such patients should be adjusted with more attention to non-relapse complications.
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Affiliation(s)
- Shan Yuan
- Division of Transfusion Medicine, Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - Dongyun Yang
- Department of Computational and Quantitative Medicine, City of Hope National Medical Center, Duarte, California, USA
| | - Ryotaro Nakamura
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California, USA
| | - Monzr M Al Malki
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California, USA
| | - Amandeep Salhotra
- Department of Hematology and Hematopoietic Cell Transplantation, City of Hope National Medical Center, Duarte, California, USA
| | - Michelle Afkhami
- Division of Molecular Pathology & Therapy Biomarkers, Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
| | - Shirong Wang
- Division of Transfusion Medicine, Department of Pathology, City of Hope National Medical Center, Duarte, California, USA
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12
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Romero I, Guerra E, Madariaga A, Manso L. Safety of bevacizumab and olaparib as frontline maintenance therapy in advanced ovarian cancer: expert review for clinical practice. Front Oncol 2024; 13:1304303. [PMID: 38348122 PMCID: PMC10859514 DOI: 10.3389/fonc.2023.1304303] [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: 09/29/2023] [Accepted: 12/26/2023] [Indexed: 02/15/2024] Open
Abstract
Olaparib, a poly(ADP-ribose) polymerase inhibitor, in combination with the antiangiogenic agent bevacizumab, is approved as maintenance therapy for patients with newly diagnosed stage III or IV epithelial ovarian cancer who have homologous recombination deficient tumors with a deleterious or suspected deleterious BRCA mutation and/or genomic instability based on the long-lasting survival benefit observed in the PAOLA-1 trial. Despite treatment with olaparib and bevacizumab showing an acceptable safety profile, the rate of discontinuations due to adverse events was relatively high, and toxicity related to this regimen may restrict its clinical use. Proper management of olaparib/bevacizumab-related adverse events is important for the improvement of quality of life and maximization of the efficacy of maintenance therapy. Here, we summarize the safety results of the PAOLA-1 study, focusing on treatment discontinuation reasons and adverse event profiles. We sought to shed light on toxicity monitoring and prevention, providing concise recommendations for the clinical management of the most relevant side effects.
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Affiliation(s)
- Ignacio Romero
- Department of Medical Oncology, Instituto Valenciano de Oncología (IVO), Valencia, Spain
| | - Eva Guerra
- Department of Medical Oncology, Ramón y Cajal University Hospital, Madrid, Spain
| | - Ainhoa Madariaga
- Department of Medical Oncology, 12 de Octubre University Hospital, Madrid, Spain
| | - Luis Manso
- Department of Medical Oncology, 12 de Octubre University Hospital, Madrid, Spain
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13
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Foy P, Friedman KD, Michaelis LC. How I diagnose and treat thrombocytopenia in geriatric patients. Blood 2024; 143:214-223. [PMID: 37956435 DOI: 10.1182/blood.2022017634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 07/31/2023] [Accepted: 08/16/2023] [Indexed: 11/15/2023] Open
Abstract
ABSTRACT Thrombocytopenia in older individuals is a common but diagnostically challenging condition that has variable clinical impact to those who are affected. Diagnostic approach requires evaluation of the preexisting clinical conditions, detailed review of medications, and assessment for disorders that warrant urgent treatment. In this article, we describe a systematic approach to diagnosis of thrombocytopenia and present a schematic review for management strategies. Three clinical scenarios are presented that are relevant for their prevalence and management challenges in an older adult population. The first scenario addresses primary immune thrombocytopenia (ITP) and reviews different treatment options. The second one addresses complications of thrombocytopenia in management of the myelodysplastic syndrome. The last one reviews diagnostic challenges of drug-induced ITP.
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Affiliation(s)
- Patrick Foy
- Department of Medicine, Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI
| | | | - Laura C Michaelis
- Department of Medicine, Division of Hematology-Oncology, Medical College of Wisconsin, Milwaukee, WI
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14
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Gur I, Tounek R, Dotan Y, Evgrafov EV, Rakedzon S, Fuchs E. Safety of Bronchoalveolar Lavage in Hematological Patients with Thrombocytopenia. A Retrospective Cohort Study. Mediterr J Hematol Infect Dis 2024; 16:e2024006. [PMID: 38223481 PMCID: PMC10786145 DOI: 10.4084/mjhid.2024.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 12/12/2023] [Indexed: 01/16/2024] Open
Abstract
Background Hospitalized hematological patients often require bronchoalveolar lavage (BAL). Scarce evidence exists regarding the potential risks in patients with very severe thrombocytopenia (VST). Methods This retrospective-cohort study included adult hematological in-patients with VST, defined as platelets<20x103/μL, undergoing BAL during 2012-2021. Mechanically ventilated patients or those with known active bleeding were excluded. Primary outcomes included major bleeding halting the BAL or deemed significant by the treating physician, need for any respiratory support other than low flow O2, or death within 24 hours. Any other bleedings were recorded as secondary outcomes. Results Of the 507 patients included in the final analysis, the 281 patients with VST had lower hemoglobin (Md=0.3, p=0.003), longer prothrombin-time (Md=0.7s, p=0.025), higher chances of preprocedural platelet transfusion (RR 3.68, 95%CI [2.86,4.73]), and only one primary-outcome event (death of septic shock 21h postprocedurally) - compared with 3 (1.3%) events (two bleedings halting procedure and one need for non-invasive-ventilation) in patients with platelets ≥20x103/μL (p=0.219). The risk of minor spontaneously resolved bleeding was higher (RR=3.217, 95% CI [0.919,11.262]) in patients with VST (4.3% vs 1.3%, p=0.051). No association was found between the complications recorded and preprocedural platelets, age, aPTT, P.T., hematological status, or platelet transfusion. Conclusions This data suggests BAL to be safe even when platelet counts are <20x103/μL.
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Affiliation(s)
- Ivan Gur
- Rambam Medical Center, Haifa, Israel
| | - Roei Tounek
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Yaniv Dotan
- Rambam Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Elite Vainer Evgrafov
- Rambam Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | | | - Eyal Fuchs
- Rambam Medical Center, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
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15
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Kayo T, Suzuki M, Mitsuma T, Suzuki M, Ikeda S, Sukegawa M, Tsunoda S, Ohta M. Bleeding Risk of Acupuncture for Patients with Hematological Malignancies Accompanying Thrombocytopenia: A Retrospective Chart Review. JOURNAL OF INTEGRATIVE AND COMPLEMENTARY MEDICINE 2024; 30:77-84. [PMID: 37405736 DOI: 10.1089/jicm.2022.0710] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Introduction: In recent years, it has been reported that acupuncture is useful for alleviating the symptoms of patients with hematological malignancies, but the safety of acupuncture for such patients has not been established. This study evaluated the risk of bleeding from acupuncture in patients with hematological malignancies accompanying thrombocytopenia. Methods: The authors performed a retrospective investigation of the medical records of patients with hematological malignancies who received acupuncture during hospitalization at the hematology department of a single medical center in Japan. The bleeding risk at the acupuncture site was evaluated in the following four groups according to the platelet count measured on the day of acupuncture treatment: (1) <20 × 103/μL, (2) 20-49 × 103/μL, (3) 50-99 × 103/μL, and (4) 100 × 103/μL or more. Occurrence of grade 2 or higher bleeding according to the Common Terminology Criteria for Adverse Events, version 5.0, within 24 h from the acupuncture session or before the next session was defined as an event, and the risk of occurrence of bleeding was examined in each group. Results: Of 2423 acupuncture sessions conducted on 51 patients with hematological malignancies, 815 were included in the analysis. Ninety sessions were performed in the <20 × 103/μL platelet count group, 161 in the 20-49 × 103/μL group, 133 in the 50-99 × 103/μL group, and 431 in the 100 × 103/μL or more group. No bleeding event according to the authors' definition occurred in any of these groups. Conclusions: This study is the largest to date to assess the bleeding risk of acupuncture in patients with hematological malignancies accompanying thrombocytopenia. The authors considered that acupuncture could be safely performed without causing serious bleeding for patients with hematological malignancies accompanying thrombocytopenia.
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Affiliation(s)
- Takumi Kayo
- Department of Kampo Medical Research Institute and Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Masao Suzuki
- Department of Kampo Medical Research Institute and Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Tadamichi Mitsuma
- Department of Kampo Medical Research Institute and Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Manabu Suzuki
- Department of Hematology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Shohei Ikeda
- Department of Hematology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Masumi Sukegawa
- Department of Hematology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Saburo Tsunoda
- Department of Hematology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
| | - Masatsugu Ohta
- Department of Hematology, Aizu Medical Center, Fukushima Medical University, Fukushima, Japan
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16
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Hess AS. What's in Your Transfusion? A Bedside Guide to Blood Products and Their Preparation. Anesthesiology 2024; 140:144-156. [PMID: 37639622 DOI: 10.1097/aln.0000000000004655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
An understanding of the contents of blood products and how they are modified before transfusion will help any physician. This article will review five basic blood products and the five most common product modifications.
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Affiliation(s)
- Aaron S Hess
- Departments of Anesthesiology and Pathology & Transfusion Medicine, University of Wisconsin-Madison, Madison, Wisconsin
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17
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Soff G, Leader A, Al-Samkari H, Falanga A, Maraveyas A, Sanfilippo K, Wang TF, Zwicker J. Management of chemotherapy-induced thrombocytopenia: guidance from the ISTH Subcommittee on Hemostasis and Malignancy. J Thromb Haemost 2024; 22:53-60. [PMID: 37827380 DOI: 10.1016/j.jtha.2023.09.031] [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: 06/14/2023] [Revised: 09/08/2023] [Accepted: 09/25/2023] [Indexed: 10/14/2023]
Abstract
Thrombocytopenia is a common adverse effect of chemotherapy. The development of chemotherapy-induced thrombocytopenia (CIT) is influenced by cancer type and therapy, occurring in approximately one-third of patients with a solid tumor diagnosis and half of all patients with a hematologic malignancy. CIT may complicate the administration of chemotherapy, leading to therapeutic delays or dose reductions. This guidance document, presented by the International Society on Thrombosis and Haemostasis (ISTH) Subcommittee on Hemostasis and Malignancy, provides a comprehensive summary of the evidence and offers direction on the use of thrombopoietin receptor agonists (TPO-RAs) in various settings of CIT, including solid tumors, acute myeloid leukemia, stem cell transplant, and lymphoma. Studies have shown that TPO-RAs can improve platelet counts in CIT, but the clinical benefits of TPO-RA in terms of reducing bleeding, limiting platelet transfusion, avoiding chemotherapy delay, or dose reduction are uncertain. Further research is needed to optimize the selection of appropriate indications and study design to manage thrombocytopenia following chemotherapy.
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Affiliation(s)
- Gerald Soff
- Department of Medicine, University of Miami Health System/Sylvester Comprehensive Cancer Center, Miami, Florida, USA.
| | - Avi Leader
- Section of Hematology, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Hanny Al-Samkari
- Classical Hematology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Anna Falanga
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - Anthony Maraveyas
- Faculty of Health Sciences, Joint Centre for Cancer Studies, The Hull York Medical School, Castle Hill Hospital, Hull, UK
| | - Kristen Sanfilippo
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri, USA. https://twitter.com/sanfilippomd
| | - Tzu-Fei Wang
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada. https://twitter.com/tzufeiwang
| | - Jeffrey Zwicker
- Section of Hematology, Memorial Sloan Kettering Cancer Center, New York, New York, USA. https://twitter.com/jzbos
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18
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Chen W, Liu Y, Li L, Zeng X. Efficacy and safety of thrombopoietin receptor agonists in solid tumors with chemotherapy-induced thrombocytopenia: a meta-analysis. BMC Pharmacol Toxicol 2023; 24:71. [PMID: 38041150 PMCID: PMC10693054 DOI: 10.1186/s40360-023-00707-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/14/2023] [Indexed: 12/03/2023] Open
Abstract
OBJECTIVE To evaluate the efficacy and safety of thrombopoietin receptor agonists (TPO-RAs) in solid tumors with chemotherapy-induced thrombocytopenia (CIT). METHODS We conducted a comprehensive search of PubMed, FMRS, Cochrane Library, Web of Science, EMBASE, and ClinicalTrials.gov for randomized controlled trials (RCTs) reporting the efficacy and safety of TPO-RAs in solid tumors with CIT. The search was limited to articles published before April 30, 2022. Primary outcomes included chemotherapy dose reduction or delays, platelet transfusion, the incidence of grade 3 or 4 thrombocytopenia, and bleeding events. Secondary outcomes encompassed the incidence of platelet count > 400 × 109/L, adverse events (AEs), serious AEs, thrombosis, and mortality. RESULTS Our analysis encompassed six studies: five rigorous RCTs and one unique study comparing romiplostim to an observation group, involving a total of 489 patients. For primary outcomes, TPO-RAs significantly reduced the incidence of grade 3 or 4 thrombocytopenia (RR = 0.69, 95% CI: 0.52-0.91). After applying the Bonferroni correction for multiple comparisons, the significance of the reduction in grade 3 or 4 thrombocytopenia incidence persisted (P = 0.008). TPO-RAs showed no significant impact on chemotherapy dose reduction or delays (RR = 0.81, 95% CI: 0.65-1.01), platelet transfusion (RR = 1.04, 95% CI: 0.48-2.27), or bleeding events (RR = 0.50, 95% CI: 0.23-1.10). In terms of safety, there were no significant difference in the incidence of any AEs (RR = 0.98, 95% CI:0.92-1.04), serious AEs (RR = 0.79, 95% CI:0.45-1.40), thrombotic events (RR = 1.20, 95% CI:0.51-2.84) and mortality (RR = 1.15, 95% CI:0.55-2.41). CONCLUSIONS This meta-analysis suggests that TPO-RAs are generally well-tolerated. However, their efficacy in solid tumors with CIT appears limited, as they only demonstrate a reduction in the incidence of grade 3 or 4 thrombocytopenia.
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Affiliation(s)
- Wen Chen
- Department of Medical Oncology, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Yubingxue Liu
- Department of Health Examination and Oncology Screening Center, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Luchun Li
- Department of Medical Oncology, Chongqing University Cancer Hospital, Chongqing, 400030, China
| | - Xianghua Zeng
- Department of Medical Oncology, Chongqing University Cancer Hospital, Chongqing, 400030, China.
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19
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Gammon R, Becker J, Cameron T, Eichbaum Q, Jindal A, Lamba DS, Nalezinski S, Rios J, Shaikh S, Shepherd J, Tanhehco YC. How do I manage a blood product shortage? Transfusion 2023; 63:2205-2213. [PMID: 37840217 DOI: 10.1111/trf.17572] [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: 06/30/2023] [Revised: 09/14/2023] [Accepted: 09/21/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The demand for blood products sometimes exceeds the available inventory. Blood product inventories are dependent upon the availability of donors, supplies and reagents, and collection staff. During prolonged extreme shortages, blood centers and transfusion services must alter practices to meet the needs of patients. STUDY DESIGN AND METHODS The Association for the Advancement of Blood and Biotherapies Donor and Blood Component Management Subsection compiled some strategies from its blood center and hospital transfusion service members that could be implemented during blood product shortages. RESULTS Some strategies that blood centers could use to increase their available inventories include increasing donor recruitment efforts, using alternate types of collection kits, manufacturing low-yield apheresis-derived platelets and/or whole blood-derived platelets, using cold-stored platelets, transferring inventory internally among centers of the same enterprise, using frozen inventory, decreasing standing order quantities, prioritizing allocation to certain patient populations, filling partial orders, and educating customers and blood center staff. Transfusion service strategies that could be implemented to maximize the use of the limited available inventory include increasing patient blood management efforts, using split units, finding alternate blood suppliers, trading blood products with other hospital transfusion services, developing a patient priority list, assembling a hospital committee to decide on triaging priorities, using expired products in extreme situations, and accepting nonconforming products after performing safety checks. DISCUSSION Blood centers and transfusion services must choose the appropriate strategies to implement based on their needs.
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Affiliation(s)
- Richard Gammon
- OneBlood, Scientific, Medical, Technical Direction, Orlando, Florida, USA
| | - Joanne Becker
- Department of Pathology and Laboratory Medicine; Blood Bank and Therapeutic Apheresis Unit, Roswell Park Comprehensive Cancer Center, and Pathology and Anatomical Sciences, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo, Buffalo, New York, USA
| | - Tracy Cameron
- Ontario Regional Blood Coordinating Network, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Quentin Eichbaum
- Vanderbilt University Medical Center (VUMC), Nashville, Tennessee, USA
| | - Aikaj Jindal
- Department of Transfusion Medicine, Mohandai Oswal Hospital, Ludhiana, India
| | - Divjot Singh Lamba
- Department of Transfusion Medicine, Post Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Shaughn Nalezinski
- Department of Laboratory Medicine Transfusion Services, Concord Hospital, Concord, New Hampshire, USA
| | - Jorge Rios
- American Red Cross Blood Services, Dedham, Massachusetts, USA
| | - Salima Shaikh
- Vitalant, Northeast Division, Montvale, New Jersey, USA
| | - Janine Shepherd
- Transfusion Services Laboratory, Denver Health Hospital, Denver, Colorado, USA
| | - Yvette C Tanhehco
- Department of Pathology and Cell Biology, Columbia University Vagelos College of Physicians and Surgeons, New York, New York, USA
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20
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Gavioli G, Razzoli A, Bedolla DE, Di Bartolomeo E, Quartieri E, Iotti B, Berni P, Birarda G, Vaccari L, Schiroli D, Marraccini C, Baricchi R, Merolle L. Cryopreservation affects platelet macromolecular composition over time after thawing and differently impacts on cancer cells behavior in vitro. Platelets 2023; 34:2281943. [PMID: 38010129 DOI: 10.1080/09537104.2023.2281943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023]
Abstract
Cryopreservation affects platelets' function, questioning their use for cancer patients. We aimed to investigate the biochemical events that occur over time after thawing to optimize transfusion timing and evaluate the effect of platelet supernatants on tumor cell behavior in vitro. We compared fresh (Fresh-PLT) with Cryopreserved platelets (Cryo-PLT) at 1 h, 3 h and 6 h after thawing. MCF-7 and HL-60 cells were cultured with Fresh- or 1 h Cryo-PLT supernatants to investigate cell proliferation, migration, and PLT-cell adhesion. We noticed a significant impairment of hemostatic activity accompanied by a post-thaw decrease of CD42b+ , which identifies the CD62P--population. FTIR spectroscopy revealed a decrease in the total protein content together with changes in their conformational structure, which identified two sub-groups: 1) Fresh and 1 h Cryo-PLT; 2) 3 h and 6 h cryo-PLT. Extracellular vesicle shedding and phosphatidylserine externalization (PS) increased after thawing. Cryo-PLT supernatants inhibited cell proliferation, impaired MCF-7 cell migration, and reduced ability to adhere to tumor cells. Within the first 3 hours after thawing, irreversible alterations of biomolecular structure occur in Cryo-PLT. Nevertheless, Cryo-PLT should be considered safe for the transfusion of cancer patients because of their insufficient capability to promote cancer cell proliferation, adhesion, or migration.
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Affiliation(s)
- Gaia Gavioli
- AUSL-IRCCS di Reggio Emilia, Transfusion Medicine Unit, Reggio Emilia, Italy
- Clinical and Experimental PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Agnese Razzoli
- AUSL-IRCCS di Reggio Emilia, Transfusion Medicine Unit, Reggio Emilia, Italy
- Clinical and Experimental PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Diana E Bedolla
- Elettra - Sincrotrone Trieste S.C.p.A, Basovizza, Italy
- Molecular Pathology Lab, International Center for Genetic Engineering and Biotechnology (ICGEB), Area Science Park, Trieste, Italy
- Center for Biospectroscopy and School of Chemistry, Monash University, Clayton, VIC, Australia
| | | | - Eleonora Quartieri
- AUSL-IRCCS di Reggio Emilia, Transfusion Medicine Unit, Reggio Emilia, Italy
| | - Barbara Iotti
- AUSL-IRCCS di Reggio Emilia, Transfusion Medicine Unit, Reggio Emilia, Italy
| | - Pamela Berni
- AUSL-IRCCS di Reggio Emilia, Transfusion Medicine Unit, Reggio Emilia, Italy
| | | | - Lisa Vaccari
- Elettra - Sincrotrone Trieste S.C.p.A, Basovizza, Italy
| | - Davide Schiroli
- AUSL-IRCCS di Reggio Emilia, Transfusion Medicine Unit, Reggio Emilia, Italy
| | - Chiara Marraccini
- AUSL-IRCCS di Reggio Emilia, Transfusion Medicine Unit, Reggio Emilia, Italy
| | - Roberto Baricchi
- AUSL-IRCCS di Reggio Emilia, Transfusion Medicine Unit, Reggio Emilia, Italy
| | - Lucia Merolle
- AUSL-IRCCS di Reggio Emilia, Transfusion Medicine Unit, Reggio Emilia, Italy
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21
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Hambardzumyan L, Grigoryan H, Badikyan M, Khachatryan H, Sargsyan N, Sulikhanyan A, Tamamyan G, Stebbing J. Disparities in the consensus for treatment of chemotherapy-induced thrombocytopenia. Ecancermedicalscience 2023; 17:1627. [PMID: 38414967 PMCID: PMC10898910 DOI: 10.3332/ecancer.2023.1627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Indexed: 02/29/2024] Open
Abstract
Introduction Chemotherapy-induced thrombocytopenia (CIT) is an arduous complication of chemotherapy to be dealt with, and there are many unmet needs in this field to be addressed on the global front. We have conducted this study to contribute to the understanding of existing knowledge gaps of CIT management and highlight the direction to focus future investigations. Methods This was an academic single-institution report on a cross-sectional study evaluating CIT management practices using platelet (PLT) transfusions by haematologists and oncologists in Armenia. Results Physicians' opinions differed significantly when it came to defining thrombocytopenia by PLT levels. 13.2% of those surveyed considered thrombocytopenia to be when PLT counts fall below 180 × 109/L, 42.1% defined thrombocytopenia to have a PLT threshold of 150 × 109/L, 15.8% and 21.0% specialists setting their thresholds at 140 × 109/L and 100 × 109/L, respectively.All physicians managed CIT by performing PLT transfusions for prophylactic purposes (i.e., when PLT count falls below a certain threshold) with none of them transfusing PLTs only on-demand to address active bleeding. 73.3% haematologists (adult), 57.1% medical oncologists, and 50% paediatricians deemed 10 × 109/L as the threshold PLT count for transfusing afebrile patients with haematologic malignancies (besides acute promyelocytic leukaemia (APL)) and solid tumours.PLT products availability varied among the respondents, with only 53% of them responding that they had 24/7 access. Conclusion CIT is a complication of interest to physicians worldwide and has not been resolved yet. This is the first conducted survey regarding CIT and the initial step for further research.
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Affiliation(s)
- Liana Hambardzumyan
- Hematology Center after Prof. R. H. Yeolyan, Yerevan 0014, Armenia
- Department of Surgery and Cancer, Imperial College, London SW7 2BX, UK
| | - Henrik Grigoryan
- Hematology Center after Prof. R. H. Yeolyan, Yerevan 0014, Armenia
- Department of Pediatric Oncology and Hematology, Yerevan State Medical University, Yerevan 0025, Armenia
- Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan 0014, Armenia
| | - Maria Badikyan
- Hematology Center after Prof. R. H. Yeolyan, Yerevan 0014, Armenia
- Immune Oncology Research Institute, Yerevan 0014, Armenia
| | - Heghine Khachatryan
- Hematology Center after Prof. R. H. Yeolyan, Yerevan 0014, Armenia
- Department of Pediatric Oncology and Hematology, Yerevan State Medical University, Yerevan 0025, Armenia
| | - Nelly Sargsyan
- Hematology Center after Prof. R. H. Yeolyan, Yerevan 0014, Armenia
- Department of Pediatric Oncology and Hematology, Yerevan State Medical University, Yerevan 0025, Armenia
| | | | - Gevorg Tamamyan
- Hematology Center after Prof. R. H. Yeolyan, Yerevan 0014, Armenia
- Department of Pediatric Oncology and Hematology, Yerevan State Medical University, Yerevan 0025, Armenia
- Pediatric Cancer and Blood Disorders Center of Armenia, Hematology Center after Prof. R. H. Yeolyan, Yerevan 0014, Armenia
- Immune Oncology Research Institute, Yerevan 0014, Armenia
| | - Justin Stebbing
- Department of Surgery and Cancer, Imperial College, London SW7 2BX, UK
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Panch SR, Guo L, Vassallo R. Platelet transfusion refractoriness due to HLA alloimmunization: Evolving paradigms in mechanisms and management. Blood Rev 2023; 62:101135. [PMID: 37805287 DOI: 10.1016/j.blre.2023.101135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/09/2023]
Abstract
Platelet transfusion refractoriness due to HLA alloimmunization presents a significant medical problem, particularly among multiply transfused patients with hematologic malignancies and those undergoing hematopoietic stem cell transplants. HLA compatible platelet transfusions also impose significant financial burden on these patients. Recently, several novel mechanisms have been described in the development of HLA alloimmunization and platelet transfusion refractoriness. We review the history of platelet transfusions and mechanisms of HLA-sensitization and transfusion refractoriness. We also summarize advances in the diagnosis and treatment of platelet transfusion refractoriness due to HLA alloimmunization.
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Affiliation(s)
- Sandhya R Panch
- Clinical Research Division, Fred Hutchinson Cancer Center, United States of America; BloodWorks NorthWest, United States of America.
| | - Li Guo
- BloodWorks NorthWest, United States of America; Division of Hematology and Oncology, University of Washington School of Medicine, United States of America
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23
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Xia X, Zhou H, Zhang H, Deng W, Li R, Huang Q, Wang Y, Xiong H. Hetrombopag plus recombinant human thrombopoietin for chemotherapy-induced thrombocytopenia in patients with solid tumors. Res Pract Thromb Haemost 2023; 7:102231. [PMID: 38077816 PMCID: PMC10704501 DOI: 10.1016/j.rpth.2023.102231] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 09/05/2023] [Accepted: 09/22/2023] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Chemotherapy-induced thrombocytopenia (CIT) is a common hematological complication in patients with cancer. Hetrombopag is a novel thrombopoietin receptor agonist that has shown an additive effect in stimulating platelet production when combined with recombinant human thrombopoietin (rhTPO). OBJECTIVES This multicenter retrospective cohort study aimed to evaluate the efficacy and safety of hetrombopag plus rhTPO compared with rhTPO alone for CIT. METHODS A total of 294 patients with solid tumors and CIT (platelet count, <50 × 109/L) who received either rhTPO plus hetrombopag (146 patients) or rhTPO alone (148 patients) at 3 centers from January to December 2022 were included in the study. The primary outcome was a platelet count at least 50 × 109/L higher than the baseline value within 14 days. Chemotherapy dose reductions/delays, bleeding, and adverse events were reported. RESULTS One hundred twenty patients (82.2%) in the rhTPO-hetrombopag group vs 100 patients (67.6%) in the rhTPO group achieved the primary outcome (P = .005). This significant difference persisted in adjusted analysis (odds ratio, 2.01; 95% CI, 1.12-3.60). A total of 115 patients (78.8%) in the rhTPO-hetrombopag group and 101 patients (68.2%) in the rhTPO group avoided chemotherapy dose reductions/delays (P = .041). There was no significant difference in bleeding rates, and adverse events were mild and similar between the 2 groups. No deaths occurred. CONCLUSION Compared to rhTPO alone, our findings suggest that the combination of hetrombopag and rhTPO is safe and more effective in patients with CIT.
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Affiliation(s)
- Xiaohui Xia
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Haiting Zhou
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hao Zhang
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wanjun Deng
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Rui Li
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qiao Huang
- Department of Oncology, Yichang Central People’s Hospital, Yichang, China
| | - Yuehua Wang
- Department of Oncology, Xiangyang Central Hospital, Xiangyang, China
| | - Huihua Xiong
- Department of Oncology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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24
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Miller L, Freed-Freundlich M, Shimoni A, Hellou T, Avigdor A, Misgav M, Canaani J. Defining Current Patterns of Blood Product Use during Intensive Induction Chemotherapy in Newly Diagnosed Acute Myeloid Leukemia Patients. Transfus Med Hemother 2023; 50:456-468. [PMID: 37899992 PMCID: PMC10601600 DOI: 10.1159/000529595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/06/2023] [Indexed: 10/31/2023] Open
Abstract
Introduction Blood product transfusion retains a critical role in the supportive care of patients with acute myeloid leukemia (AML). Whereas previous studies have shown increased transfusion dependency to portend inferior outcome, predictive factors of an increased transfusion burden and the prognostic impact of transfusion support have not been assessed recently. Methods/Patients We performed a retrospective analysis on a recent cohort of patients given intensive induction chemotherapy in 2014-2022. Results The analysis comprised 180 patients with a median age of 57 years with 80% designated as de novo AML. Fifty-four patients (31%) were FLT3-ITD mutated, and 73 patients (42%) harbored NPM1. Favorable risk and intermediate risk ELN 2017 patients accounted for 43% and 34% of patients, respectively. The median number of red blood cell (RBC) and platelet units given during induction were 9 and 7 units, respectively. Seventeen patients (9%) received cryoprecipitate, and fresh frozen plasma (FFP) was given to 12 patients (7%). Lower initial hemoglobin and platelet levels were predictive of increased use of RBC (p < 0.0001) and platelet transfusions (p < 0.0001). FFP was significantly associated with induction related mortality (42% vs. 5%; p < 0.0001) and with FLT3-ITD (72% vs. 28%; p = 0.004). Blood group AB experienced improved mean overall survival compared to blood group O patients (4.1 years vs. 2.8 years; p = 0.025). In multivariate analysis, increased number of FFP (hazard ratio [HR], 4.23; 95% confidence interval [CI], 2.1-8.6; p < 0.001) and RBC units (HR, 1.8; 95% CI, 1.2-2.8; p = 0.008) given was associated with inferior survival. Conclusion Transfusion needs during induction crucially impact the clinical trajectory of AML patients.
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Affiliation(s)
- Liron Miller
- Blood Bank and Transfusion Service, Chaim Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Mor Freed-Freundlich
- Hematology Division, Chaim Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Avichai Shimoni
- Hematology Division, Chaim Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Tamer Hellou
- Hematology Division, Chaim Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Abraham Avigdor
- Hematology Division, Chaim Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Mudi Misgav
- Blood Bank and Transfusion Service, Chaim Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
| | - Jonathan Canaani
- Hematology Division, Chaim Sheba Medical Center, Faculty of Medicine, Tel Aviv University, Tel Hashomer, Israel
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25
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Regalado-Artamendi I, García-Fasanella M, Medina L, Fernandez-Sojo J, Esquirol A, García-Cadenas I, Martino R, Briones J, Sierra J, Novelli S. Age, CD34+ cell dose, conditioning and pre-transplant cytopenias can help predict transfusion support in lymphoma patients undergoing autologous stem cell transplantation. Vox Sang 2023; 118:681-689. [PMID: 37356813 DOI: 10.1111/vox.13486] [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: 11/29/2022] [Revised: 05/26/2023] [Accepted: 06/07/2023] [Indexed: 06/27/2023]
Abstract
BACKGROUND AND OBJECTIVES Autologous stem cell transplant (ASCT) is a widely used therapy for lymphoma patients and can nowadays be performed on an outpatient basis. This study aimed to describe transfusion support in lymphoma patients undergoing ASCT and identify increased or prolonged transfusion requirement predictors. MATERIALS AND METHODS A retrospective study of all consecutive lymphoma patients undergoing ASCT between 2010 and 2020. RESULTS Out of 226 patients, 145 (64%) received red blood cell (RBC) transfusions, whereas all 226 (100%) required platelet transfusion (PT). Transfusions between Day +1 and +30 were higher in patients over 60 (2 [1-4] vs. 2 [0-2] RBC; p = 0.001 and 4 [2-8] vs. 3 [2-4] PT; p < 0.001); patients with pre-transplant anaemia (4 [2.5-6] vs. 2 [0-2] RBC; p < 0.001 and 5 [3-9] vs. 3 [2-4] PT; p = 0.001); pre-transplant thrombocytopenia (2 [1-4] vs. 2 [0-2] RBC; p < 0.001 and 4 [3-8.5] vs. 2 [1-3] PT; p < 0.001) or CD34+ cell dose <4 × 106 /kg (2 [0-4] vs. 2 [0-2] RBC; p = 0.024 and 4 [2-6] vs. 2 [1-3.5] PT; p < 0.001). RBC transfusion independence was reached later in patients receiving carmustine, cytarabine, etoposide and melphalan (BEAM) (hazard ratio [HR] 1.6; confidence interval [CI] 1.1-2.3) and those requiring RBC before infusion and/or with pre-transplant anaemia (HR 2.2; CI 1.4-3.4). Age above 60 (HR 1.4; CI 1.0-1.9), BEAM conditioning (HR 1.4; CI 1.0-2.0) and pre-transplant thrombocytopenia and/or requiring PT before infusion (HR 1.8; CI 1.4-2.5) entailed longer time until PT independence. CONCLUSION These four factors (age ≥60 years; BEAM conditioning, CD34+ dose <4 × 106 /kg and pre-transplant cytopenia and/or Day -10 to 0 transfusion) allowed dividing patients into three groups with significant differences between them regarding the time until transfusion independence.
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Affiliation(s)
- Isabel Regalado-Artamendi
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | | | - Laura Medina
- Banc de Sang i Teixits de Catalunya, Barcelona, Spain
| | | | - Albert Esquirol
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Irene García-Cadenas
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Rodrigo Martino
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Javier Briones
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Jorge Sierra
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
- Universitat Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Silvana Novelli
- Hematology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Institut d'Investigació Biomèdica Sant Pau (IIB-Sant Pau), Barcelona, Spain
- Instituto de Investigación contra la Leucemia Josep Carreras (IJC), Barcelona, Spain
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26
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Robinson MD, McNamara MG, Clouston HW, Sutton PA, Hubner RA, Valle JW. Patients Undergoing Systemic Anti-Cancer Therapy Who Require Surgical Intervention: What Surgeons Need to Know. Cancers (Basel) 2023; 15:3781. [PMID: 37568597 PMCID: PMC10417541 DOI: 10.3390/cancers15153781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/15/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
As part of routine cancer care, patients may undergo elective surgery with the aim of long-term cure. Some of these patients will receive systemic anti-cancer therapy (SACT) in the neoadjuvant and adjuvant settings. The majority of patients, usually with locally advanced or metastatic disease, will receive SACT with palliative intent. These treatment options are expanding beyond traditional chemotherapy to include targeted therapies, immunotherapy, hormone therapy, radionuclide therapy and gene therapy. During treatment, some patients will require surgical intervention on an urgent or emergency basis. This narrative review examined the evidence base for SACT-associated surgical risk and the precautions that a surgical team should consider in patients undergoing SACT.
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Affiliation(s)
- Matthew D. Robinson
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9NT, UK
| | - Mairéad G. McNamara
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9NT, UK
- Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Hamish W. Clouston
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9NT, UK
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Paul A. Sutton
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9NT, UK
- Colorectal and Peritoneal Oncology Centre, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Richard A. Hubner
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9NT, UK
- Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
| | - Juan W. Valle
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester M13 9NT, UK
- Department of Medical Oncology, ENETS Centre of Excellence, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK
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27
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Weller M, Le Rhun E, Van den Bent M, Chang SM, Cloughesy TF, Goldbrunner R, Hong YK, Jalali R, Jenkinson MD, Minniti G, Nagane M, Razis E, Roth P, Rudà R, Tabatabai G, Wen PY, Short SC, Preusser M. Diagnosis and management of complications from the treatment of primary central nervous system tumors in adults. Neuro Oncol 2023; 25:1200-1224. [PMID: 36843451 PMCID: PMC10326495 DOI: 10.1093/neuonc/noad038] [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: 10/17/2022] [Indexed: 02/28/2023] Open
Abstract
Central nervous system (CNS) tumor patients commonly undergo multimodality treatment in the course of their disease. Adverse effects and complications from these interventions have not been systematically studied, but pose significant challenges in clinical practice and impact function and quality of life, especially in the management of long-term brain tumor survivors. Here, the European Association of Neuro-Oncology (EANO) has developed recommendations to prevent, diagnose, and manage adverse effects and complications in the adult primary brain CNS tumor (except lymphomas) patient population with a specific focus on surgery, radiotherapy, and pharmacotherapy. Specifically, we also provide recommendations for dose adaptations, interruptions, and reexposure for pharmacotherapy that may serve as a reference for the management of standard of care in clinical trials. We also summarize which interventions are unnecessary, inactive or contraindicated. This consensus paper should serve as a reference for the conduct of standard therapy within and outside of clinical trials.
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Affiliation(s)
- Michael Weller
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Emilie Le Rhun
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
- Department of Neurosurgery, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
| | - Martin Van den Bent
- The Brain Tumour Center at the Erasmus MC Cancer Institute, Rotterdam, The Netherlands
| | - Susan M Chang
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Timothy F Cloughesy
- Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Roland Goldbrunner
- Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany
| | - Yong-Kil Hong
- Brain Tumor Center, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Rakesh Jalali
- Neuro Oncology Cancer Management Team, Apollo Proton Cancer Centre, Chennai, India
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust & University of Liverpool, Liverpool, UK
| | - Giuseppe Minniti
- Department of Medicine, Surgery and Neurosciences, University of Siena, Policlinico Le Scotte, Siena, Italy
- IRCCS Neuromed, Pozzilli, IS, Italy
| | - Motoo Nagane
- Department of Neurosurgery, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Evangelia Razis
- Third Department of Medical Oncology, Hygeia Hospital, Marousi, Athens, Greece
| | - Patrick Roth
- Department of Neurology, University Hospital and University of Zurich, Zurich, Switzerland
| | - Roberta Rudà
- Division of Neuro-Oncology, Department of Neuroscience, City of Health and Science and University of Turin, Turin, Italy
| | - Ghazaleh Tabatabai
- Department of Neurology & Neuro-Oncology, Hertie Institute for Clinical Brain Research, Center for Neurooncology, Comprehensive Cancer Center, German Cancer Consortium (DKTK), Partner site Tübingen, University Hospital Tübingen, Eberhard Karls University Tübingen, Tübingen, Germany
| | - Patrick Y Wen
- Center for Neuro-oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Susan C Short
- Leeds Institute of Medical Research, University of Leeds, Leeds, UK
- Department of Clinical Oncology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Matthias Preusser
- Division of Oncology, Department of Medicine 1, Medical University, Vienna, Austria
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28
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Adane T, Enawgaw B. Human leukocyte antigen alloimmunization prevention mechanisms in blood transfusion. Asian J Transfus Sci 2023; 17:264-272. [PMID: 38274979 PMCID: PMC10807525 DOI: 10.4103/ajts.ajts_144_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 11/01/2021] [Accepted: 12/05/2021] [Indexed: 11/04/2022] Open
Abstract
In many fields of clinical medicine and blood transfusion, the human leukocyte antigen (HLA) system is crucial. Alloimmunization happens as a result of an immune response to foreign antigens encountered during blood transfusion. This gives rise to alloantibodies against red blood cells (RBCs), HLA, or human platelet antigen (HPA). HLA alloimmunization following allogeneic transfusion was shown to be a result of contaminating white blood cells (WBCs) present in the product. It is a common complication of transfusion therapy that leads to difficulties in clinical intolerance and refractoriness to platelet transfusion during patient management. Single-donor platelets, prophylactic HLA matching, leukoreduction, and irradiation of cellular blood products are some of the mechanisms to prevent HLA alloimmunization during a blood transfusion. Now, the best approach to reduce the occurrence of primary HLA alloimmunization is the removal of WBCs from the blood by filtration.
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Affiliation(s)
- Tiruneh Adane
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Bamlaku Enawgaw
- Department of Hematology and Immunohematology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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29
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Morden FTC, Caballero CG, Abella M, Conching A, Gang H, Noh T. Middle meningeal artery embolization for symptomatic chronic subdural hematoma in the setting of severe transfusion-refractory thrombocytopenia: A case study and review of literature. Surg Neurol Int 2023; 14:223. [PMID: 37404508 PMCID: PMC10316227 DOI: 10.25259/sni_1051_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Accepted: 06/03/2023] [Indexed: 07/06/2023] Open
Abstract
Background Surgical decompression for the treatment of chronic subdural hematomas (cSDHs) is irrefutably effective; however, its utility in managing cSDH in patients with comorbid coagulopathy remains controversial. The optimal threshold for platelet transfusion in cSDH management is <100,000/mm3, according to guidelines from the American Association of Blood Banks GRADE framework. This threshold may be unachievable in refractory thrombocytopenia, though surgical intervention may still be warranted. We present a patient with symptomatic cSDH and transfusion-refractory thrombocytopenia successfully treated with middle meningeal artery embolization (eMMA). We also review the literature to identify management approaches for cSDH with severe thrombocytopenia. Case Description A 74-year-old male with acute myeloid leukemia presented to the emergency department with persistent headache and emesis following fall without head trauma. Computed tomography (CT) revealed a 12 mm right-sided, mixed density SDH. Platelets were <2000/mm3 initially, which stabilized to 20,000 following platelet transfusions. He then underwent right eMMA without surgical evacuation. He received intermittent platelet transfusions with platelet goal >20,000 and was discharged on hospital day 24 with resolving SDH on CT. Conclusion High-risk surgical patients with refractory thrombocytopenia and symptomatic cSDH may be successfully treated with eMMA without surgical evacuation. A platelet goal of 20,000/mm3 before and following surgical intervention proved beneficial for our patient. Similarly, a literature review of seven cases of cSDH with comorbid thrombocytopenia revealed five patients undergoing surgical evacuation following initial medical management. Three cases reported a platelet goal of 20,000. All seven cases resulted in stable or resolving SDH with platelets >20,000 at discharge.
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Affiliation(s)
- Frances Tiffany Cava Morden
- Corresponding author: Frances Tiffany Cava Morden, Division of Neurological Surgery, University of Hawaii John A. Burns School of Medicine, Honolulu, Hawaii, United States.
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30
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Boulet N, Lefrant JY, Mimoz O, Roger C, Pirracchio R. Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia. Anaesth Crit Care Pain Med 2023:101271. [PMID: 37356619 DOI: 10.1016/j.accpm.2023.101271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 06/20/2023] [Indexed: 06/27/2023]
Affiliation(s)
- Nicolas Boulet
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
| | - Jean Yves Lefrant
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
| | - Olivier Mimoz
- Services des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers 86021, France; Université de Poitiers, Inserm U1070, Poitiers, France.
| | - Claire Roger
- UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
| | - Romain Pirracchio
- Department of Anesthesia and Perioperative Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, CA, United States; Division of Biostatistics, School of Public Health, University of California Berkeley, Berkeley, CA, United States.
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Zarama V, Revelo-Noguera J, Quintero JA, Manzano R, Uribe-Buriticá FL, Carvajal DF, Ochoa LM, Valencia-Orozco A, Sánchez ÁI, Ospina-Tascón GA. Prophylactic platelet transfusion and risk of bleeding associated with ultrasound-guided central venous access in patients with severe thrombocytopenia. Acad Emerg Med 2023; 30:644-652. [PMID: 36587310 DOI: 10.1111/acem.14651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/23/2022] [Accepted: 12/24/2022] [Indexed: 01/02/2023]
Abstract
BACKGROUND Reported risk of bleeding complications after central catheter access in patients with thrombocytopenia is highly variable. Current guidelines recommend routine prophylactic platelet (PLT) transfusion before central venous catheter placement in patients with severe thrombocytopenia. Nevertheless, the strength of such recommendations is weak and supported by observational studies including few patients with very low PLT counts (<20 × 109 /L). This study aims to assess the risk of bleeding complications related to using or not using prophylactic PLT transfusion before ultrasound-guided central venous access in patients with very low PLT counts. METHODS This was a retrospective cohort study of patients with very low PLT counts (<20 × 109 /L) subjected to ultrasound-guided central venous catheterization between January 2011 and November 2019 in a university hospital. Bleeding complications were graded according to the Common Terminology Criteria for Adverse Events. A multivariate logistic regression was conducted to assess the risk of major and minor bleeding complications comparing patients who did or did not receive prophylactic PLT transfusion for the procedure. Multiple imputation by chained equations was used to handle missing data. A two-tailed p < 0.05 was considered statistically significant. RESULTS Among 221 patients with very low PLT counts, 72 received prophylactic PLT transfusions while 149 did not. Baseline characteristics were similar between transfused and nontransfused patients. No major bleeding events were identified, while minor bleeding events were recognized in 35.7% of patients. Multivariate logistic regression analysis showed no significant differences in bleeding complications between patients who received prophylactic PLT transfusions and those who did not (odds ratio 0.83, 95% confidence interval 0.45-1.55, p = 0.567). Additional complete case and sensitivity analyses yielded results similar to those of the main analysis. CONCLUSIONS In this single-center retrospective cohort study of ultrasound-guided central venous access in patients with very low PLT counts, no major bleeding was identified, and prophylactic PLT transfusions did not significantly decrease minor bleeding events.
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Affiliation(s)
- Virginia Zarama
- Department of Emergency Medicine, Fundación Valle del Lili, Cali, Colombia
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | | | - Jaime A Quintero
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
| | - Ramiro Manzano
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
| | | | | | - Laura M Ochoa
- Facultad de Ciencias de la Salud, Universidad Icesi, Cali, Colombia
| | | | - Álvaro I Sánchez
- Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia
- Division of Thoracic Surgery, Department of Surgery, Fundación Valle del Lili, Cali, Colombia
| | - Gustavo A Ospina-Tascón
- Department of Intensive Care, Fundación Valle del Lili, Cali, Colombia
- Translational Research Laboratory in in Critical Care Medicine (TransLab - CCM), Universidad Icesi, Cali, Colombia
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32
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van Baarle FLF, van de Weerdt EK, van der Velden WJFM, Ruiterkamp RA, Tuinman PR, Ypma PF, van den Bergh WM, Demandt AMP, Kerver ED, Jansen AJG, Westerweel PE, Arbous SM, Determann RM, van Mook WNKA, Koeman M, Mäkelburg ABU, van Lienden KP, Binnekade JM, Biemond BJ, Vlaar APJ. Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia. N Engl J Med 2023; 388:1956-1965. [PMID: 37224197 DOI: 10.1056/nejmoa2214322] [Citation(s) in RCA: 21] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Transfusion guidelines regarding platelet-count thresholds before the placement of a central venous catheter (CVC) offer conflicting recommendations because of a lack of good-quality evidence. The routine use of ultrasound guidance has decreased CVC-related bleeding complications. METHODS In a multicenter, randomized, controlled, noninferiority trial, we randomly assigned patients with severe thrombocytopenia (platelet count, 10,000 to 50,000 per cubic millimeter) who were being treated on the hematology ward or in the intensive care unit to receive either one unit of prophylactic platelet transfusion or no platelet transfusion before ultrasound-guided CVC placement. The primary outcome was catheter-related bleeding of grade 2 to 4; a key secondary outcome was grade 3 or 4 bleeding. The noninferiority margin was an upper boundary of the 90% confidence interval of 3.5 for the relative risk. RESULTS We included 373 episodes of CVC placement involving 338 patients in the per-protocol primary analysis. Catheter-related bleeding of grade 2 to 4 occurred in 9 of 188 patients (4.8%) in the transfusion group and in 22 of 185 patients (11.9%) in the no-transfusion group (relative risk, 2.45; 90% confidence interval [CI], 1.27 to 4.70). Catheter-related bleeding of grade 3 or 4 occurred in 4 of 188 patients (2.1%) in the transfusion group and in 9 of 185 patients (4.9%) in the no-transfusion group (relative risk, 2.43; 95% CI, 0.75 to 7.93). A total of 15 adverse events were observed; of these events, 13 (all grade 3 catheter-related bleeding [4 in the transfusion group and 9 in the no-transfusion group]) were categorized as serious. The net savings of withholding prophylactic platelet transfusion before CVC placement was $410 per catheter placement. CONCLUSIONS The withholding of prophylactic platelet transfusion before CVC placement in patients with a platelet count of 10,000 to 50,000 per cubic millimeter did not meet the predefined margin for noninferiority and resulted in more CVC-related bleeding events than prophylactic platelet transfusion. (Funded by ZonMw; PACER Dutch Trial Register number, NL5534.).
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Affiliation(s)
- Floor L F van Baarle
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Emma K van de Weerdt
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Walter J F M van der Velden
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Roelof A Ruiterkamp
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Pieter R Tuinman
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Paula F Ypma
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Walter M van den Bergh
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Astrid M P Demandt
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Emile D Kerver
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - A J Gerard Jansen
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Peter E Westerweel
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Sesmu M Arbous
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Rogier M Determann
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Walther N K A van Mook
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Mirelle Koeman
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Anja B U Mäkelburg
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Krijn P van Lienden
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Jan M Binnekade
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Bart J Biemond
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
| | - Alexander P J Vlaar
- From the Departments of Intensive Care Medicine (F.L.F.B., E.K.W., J.M.B., A.P.J.V.) and Hematology (B.J.B.) and the Laboratory of Experimental Intensive Care and Anesthesiology (F.L.F.B., E.K.W., A.P.J.V.), Amsterdam University Medical Centers location University of Amsterdam, the Department of Intensive Care Medicine, Amsterdam University Medical Centers location Vrije Universiteit Amsterdam (P.R.T.), and the Departments of Oncology (E.D.K.) and Intensive Care Medicine (R.M.D.), OLVG, Amsterdam, the Department of Hematology, Radboud University Medical Center, Nijmegen (W.J.F.M.V., R.A.R.), the Departments of Hematology (P.F.Y.) and Intensive Care Medicine (M.K.), Haga Ziekenhuis, the Hague, the Departments of Critical Care (W.M.B.) and Hematology (A.B.U.M.), University Medical Center Groningen, University of Groningen, Groningen, the Departments of Hematology (A.M.P.D.) and Intensive Care Medicine (W.N.K.A.M.), Maastricht University Medical Center, Maastricht, the Department of Hematology, Erasmus Medical Center, University Medical Center Rotterdam, Rotterdam (A.J.G.J.), the Department of Internal Medicine, Albert Schweitzer Ziekenhuis, Dordrecht (P.E.W.), the Department of Intensive Care Medicine, Leiden University Medical Center, Leiden (S.M.A.), and the Department of Interventional Radiology, St. Antonius Ziekenhuis, Nieuwegein (K.P.L.) - all in the Netherlands
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Lasky B, Singh U, Young PP. Young apheresis platelet donors show significant and sustained growth over the last decade in the US, 2010-2019: A favorable sign of the resiliency of the platelet supply. Transfusion 2023. [PMID: 37191295 DOI: 10.1111/trf.17400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/26/2023] [Accepted: 04/26/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Platelet demand continues to rise and US hospitals frequently face shortages. The peak median age of apheresis platelet donors (APD) is believed to have increased over the last decade, raising concerns that the APD base is not being adequately replenished with young donors. STUDY DESIGN/METHODS American Red Cross (ARC) apheresis platelet collections were evaluated from calendar years 2010 through 2019. APD, products per procedure/split rate (PPP) and donation frequencies were stratified into age groups. RESULTS/FINDINGS The number of unique APD from calendar year 2010 through 2019 in the ARC donor pool increased from 87,573 to 115,372 donors, representing a 31.7% overall growth. Donors in the 16-40 year-old (y) age group increased by 78.8% overall, with the largest absolute increases seen in the 26-30 y (4852 donors, 99.9% growth), followed by the 31-35 y (3991, 94.1%) group. Donors aged 56+ increased by 50.4% overall, with the largest increase seen in the 66-70 y (5988 donors, 108.1% growth) group. Middle-aged donors, aged 41-55 y, demonstrated a decrease of 16.5%. Over the last decade, the youngest age groups (16-40 y) comprised 61.3% of first-time donors (FTD). Annual donation frequency increased with increasing age and PPP. The highest donation frequencies were seen in the oldest age groups. CONCLUSION Although the peak median age of APD increased over the study period, relative contribution of the 16-40 y APD base also increased. Older donors exhibited the highest donation frequencies and thus contributed the largest volume of apheresis platelet units. Platelet donor activity declined in the middle age (41-55 y) group.
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Affiliation(s)
- Baia Lasky
- American Red Cross, Biomedical Services Division, Washington, District of Columbia, USA
| | - Umesh Singh
- American Red Cross, Biomedical Services Division, Washington, District of Columbia, USA
| | - Pampee P Young
- American Red Cross, Biomedical Services Division, Washington, District of Columbia, USA
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Stupakova Z, Diagil I, Melnyk U, Karnabeda O, Sergeieva A. Primary hemostasis dysfunctions and bleeding risk in newly diagnosed acute myeloid leukemia. J Cancer Res Clin Oncol 2023:10.1007/s00432-023-04751-w. [PMID: 37060474 DOI: 10.1007/s00432-023-04751-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 04/06/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Acute myeloid leukaemia carries the risk of complications associated with dysfunctions in haemostasis system. The purpose of this study was to investigate the factors associated with the risk of bleeding in patients with newly diagnosed acute myeloid leukaemia (AML). METHODS This study involved the methods of immunoenzymatic analysis and classical coagulation studies. The number of biochemical parameters important for establishing coagulative dysfunction in acute myeloid leukaemia was determined, the main ones being the level of von Willebrand factor, the Ristocetin-cofactor activity of von Willebrand factor and factor VIII activity, prothrombin time, platelet count, and fibrinogen concentration. RESULTS According to the results of the present study, the reduced activity of von Willebrand factor in patients with AML was associated with severe bleeding. The authors observed an increase in the number of platelets count in patients with AML who experienced haemorrhages compared to patients with no bleeding signs. The study also established an increase in the concentration of fibrinogen in cancer patients, compared to the control sample. Symptoms and quantitative indicators for diagnosing the severity of haemorrhagic syndrome were grouped. The authors considered the advantages and disadvantages of many therapeutic preparations and focussed on specific markers of activated haemorrhage-predicting platelets. CONCLUSION Further studies concern the search for effective markers and therapeutic approaches to minimize haemorrhagic syndrome. The results were statistically processed using the functions ANOVA, t test, CORREL, determination of the value of reliability, and mean square deviation.
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Affiliation(s)
- Zinaida Stupakova
- Department of Radiologic Hematology, National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine.
| | - Iryna Diagil
- Department of Radiologic Hematology, National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
| | | | | | - Anna Sergeieva
- Department of Radiologic Hematology, National Research Center for Radiation Medicine of the National Academy of Medical Sciences of Ukraine, Kyiv, Ukraine
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Ali K, Müller TH, Garritsen HSP, Harringer W, Doescher A. Digital polymerase chain reaction to monitor platelet transfusions in cardiac surgery patients. Vox Sang 2023; 118:384-391. [PMID: 36912154 DOI: 10.1111/vox.13422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 02/17/2023] [Accepted: 02/25/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND AND OBJECTIVES Corrected count increment (CCI) measurements monitor the effectiveness of platelet transfusions in haemato-oncology, but they usually fail in patients undergoing cardiac surgery. We investigated whether polymerase chain reaction (PCR) of mitochondrial single-nucleotide polymorphisms (SNPs) is able to monitor the survival of transfused platelets in these patients. MATERIALS AND METHODS Leukocyte-free, platelet-rich plasma was prepared from patients' blood to measure platelet counts based on patient-/donor-specific SNPs by digital PCR after DNA extraction. Platelet counts in samples from patients with severe thrombocytopenia were analysed by both PCR and flow cytometry. Ten patients undergoing cardiac surgery with the use of heart lung machine and without overt bleeding received a single apheresis platelet concentrate because of either dual platelet inhibition during a non-elective intervention or a complex procedure. Blood samples were collected at nine defined intervals (0-120 h) post transfusion. RESULTS The digital PCR of the seven SNPs reliably quantified levels ≥0.6 G/L platelets, in good agreement with flow cytometry and without interference by other SNPs or by platelet activation. A mean 24-h CCI of 11.8 (range: 5.6-19.8) and a mean 120-h area under the curve (AUC) of 1386 (915-1821) hxG/L were observed for the transfused platelets. The mean AUC of 14,103 (3415-27,305) hxG/L for the patients' endogenous platelets indicates that transfused platelets represented only 11% (5-25) of the total platelet counts during 120 h post transfusion. CONCLUSION PCR of mitochondrial SNPs offers a tool to assess the survival of platelets from apheresis concentrates in cardiac surgery patients to facilitate the implementation of improved transfusion strategies.
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Affiliation(s)
- Khaldoun Ali
- Clinic for Cardiac, Thoracic and Vascular Surgery, Klinikum Braunschweig GmbH, Braunschweig, Germany
| | - Thomas H Müller
- Institute for Clinical Transfusion Medicine, Klinikum Braunschweig GmbH, Braunschweig, Germany
| | - Henk S P Garritsen
- Institute for Clinical Transfusion Medicine, Klinikum Braunschweig GmbH, Braunschweig, Germany.,Department of Atmospheric Pressure Plasma Processes, Fraunhofer Institute for Surface Engineering and Thin Films IST, Braunschweig, Germany
| | - Wolfgang Harringer
- Clinic for Cardiac, Thoracic and Vascular Surgery, Klinikum Braunschweig GmbH, Braunschweig, Germany
| | - Andrea Doescher
- Department of Transfusion Medicine, Blood Donor Service NSTOB, Oldenburg, Germany
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36
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Myelotoxicity of Temozolomide Treatment in Patients with Glioblastoma Is It Time for a More Mechanistic Approach? Cancers (Basel) 2023; 15:cancers15051561. [PMID: 36900352 PMCID: PMC10000921 DOI: 10.3390/cancers15051561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 02/27/2023] [Indexed: 03/06/2023] Open
Abstract
Glioblastoma multiforme is the most common primary central nervous system tumor, with an incidence of 3 [...].
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37
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Song X, Qi J, Fang K, Li X, Han Y. A meta-analysis of risk factors associated with platelet transfusion refractoriness. Int J Hematol 2023; 117:863-875. [PMID: 36856992 DOI: 10.1007/s12185-023-03557-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 02/01/2023] [Accepted: 02/02/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Platelet transfusion refractoriness (PTR) remains an intractable issue in clinical practice, and is common in hematological patients. At present, it is believed that both immune and non-immune factors play a role. We conducted a meta-analysis of various risk factors which may contribute to PTR. METHODS PubMed, Embase, Cochrane library, and Web of Science were selected as research database platforms. Citations included were further assessed for quality and bias using the Newcastle-Ottawa Scale. All analyses were performed using Review Manager Version 5.4 and STATA 16.0. RESULTS The preliminary search revealed 1069 publications, and 17 (5929 patients in total) were ultimately included in the quantitative analysis. The following variables were associated with the occurrence of PTR: fever (OR = 2.26, 95%CI 2.00-2.55, p < 0.00001), bleeding (OR = 2.10, 95%CI 1.36-3.24, p = 0.0008), female sex (OR = 2.06, 95%CI 1.13-3.75, p = 0.02), antibiotic use (OR = 2.94, 95%CI 1.54-5.59, p = 0.001), and infection (OR = 2.19, 95%CI 1.20-4.03, p = 0.01). Antibodies involved in immune activation were a higher risk factor (OR = 4.17, 95%CI 2.36-7.36, p < 0.00001), and splenomegaly was nearly significant (OR = 1.73, 95%CI 0.97-3.07, p = 0.06). CONCLUSIONS We identified some important risk factors for PTR, but further research is needed to identify the many other possible elements that may contribute to or mediate PTR.
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Affiliation(s)
- Xiaofei Song
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Jiaqian Qi
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China
| | - Kun Fang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xueqian Li
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China.,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China.,Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China
| | - Yue Han
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, 188 Shizi Street, Suzhou, 215006, Jiangsu, China. .,Institute of Blood and Marrow Transplantation, Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China. .,Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Suzhou, China. .,State Key Laboratory of Radiation Medicine and Protection, Soochow University, Suzhou, China.
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38
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Jordan A, Jain AG, Koipallil GK, Reddy M, Chakkoli S, Midha S, Phuoc V, Eatrides J, Erhardt C, Patel AK, Rico J, Visweshar N, Mhaskar R, Parikh N, Laber D, Jaglal M. Can we lower the platelet threshold of ≥ 50 × 10 9/L for performing a lumbar puncture safely in patients with hematological malignancies? Ann Hematol 2023; 102:663-668. [PMID: 36534146 DOI: 10.1007/s00277-022-05073-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 12/09/2022] [Indexed: 12/23/2022]
Abstract
Lumbar punctures (LP) are routinely used to administer intrathecal chemotherapy for children and adults with hematologic malignancies. The current guidelines suggest a platelet threshold of ≥ 50 × 109/L prior to LP for intrathecal chemotherapy (ITC). This can be challenging in patients with hematological malignancies who are thrombocytopenic. We conducted a retrospective chart review of 900 LPs for ITC and compared adverse events in patients with a platelet count of ≥ 50 × 109/L and < 50 × 109/L. Cohort 1 included 682 LPs (75.8%) with a pre-procedure platelet count ≥ 50 × 109/L, and cohort 2 included 218 LPs (24.2%) with a pre-procedure platelet count < 50 × 109/L. Cohort 2 was further subdivided into pre-procedure platelet counts of 41 × 109/L-49 × 109/L (n = 43), 31 × 109/L-40 × 109/L (n = 77), 21 × 109/L-30 × 109/L (n = 84), and 11 × 109/L-20 × 109/L (n = 14). Among 900 LP procedures, a pre-procedure platelet count < 50 × 109/L did not demonstrate a higher rate of post-procedure adverse events (6.5% vs 6.8%, p = 0.8237). When cohort 2 was further stratified, the cohort with a pre-procedure platelet count of 21 × 109/L-30 × 109/L had the highest percentage of complications from LP (9.5%) and the highest rates of traumatic taps with observed LP RBC count > 200 (35.7%, p = 0.0015). The rate of red blood cells (RBC) in the CSF was significantly higher in the group with platelets < 50 × 109/L with observed LP RBC count ≥ 200 (31.2% vs 20.5%, p = 0.0016), ≥ 500 (27.1% vs 14.6%, p < 0.0001), and ≥ 1000 (23% vs 11.6%, p < 0.0001). No instances of epidural hematomas were seen. We found no significant difference in bleeding complications between patients undergoing LPs for ITC with a platelet count above or below 50 × 109/L.
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Affiliation(s)
- Aryanna Jordan
- Department of Internal Medicine, University of South Florida, Tampa, FL, USA.
| | - Akriti G Jain
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | | | - Meghana Reddy
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Sanjay Chakkoli
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Shonali Midha
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Vania Phuoc
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Jennifer Eatrides
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Crystal Erhardt
- H. Lee Moffitt Center and Research Institute, Tampa, FL, USA
| | - Ankita K Patel
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Juan Rico
- Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Nathan Visweshar
- Department of Internal Medicine, Division of Hematology and Oncology, University of South Florida, Tampa, FL, USA
| | - Rahul Mhaskar
- University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Nainesh Parikh
- H. Lee Moffitt Center and Research Institute, Tampa, FL, USA
| | - Damian Laber
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Michael Jaglal
- Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Biolato M, Vitale F, Galasso T, Gasbarrini A, Grieco A. Minimum platelet count threshold before invasive procedures in cirrhosis: Evolution of the guidelines. World J Gastrointest Surg 2023; 15:127-141. [PMID: 36896308 PMCID: PMC9988645 DOI: 10.4240/wjgs.v15.i2.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 12/09/2022] [Accepted: 02/07/2023] [Indexed: 02/27/2023] Open
Abstract
Cirrhotic patients with severe thrombocytopenia are at increased risk of bleeding during invasive procedures. The need for preprocedural prophylaxis aimed at reducing the risk of bleeding in cirrhotic patients with thrombocytopenia who undergo scheduled procedures is assessed via the platelet count; however, establishing a minimum threshold considered safe is challenging. A platelet count ≥ 50000/μL is a frequent target, but levels vary by provider, procedure, and specific patient. Over the years, this value has changed several times according to the different guidelines proposed in the literature. According to the latest guidelines, many procedures can be performed at any level of platelet count, which should not necessarily be checked before the procedure. In this review, we aim to investigate and describe how the guidelines have evolved in recent years in the evaluation of the minimum platelet count threshold required to perform different invasive procedures, according to their bleeding risk.
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Affiliation(s)
- Marco Biolato
- Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Internal Medicine, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Federica Vitale
- Department of Internal Medicine, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Tiziano Galasso
- Department of Internal Medicine, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Internal Medicine, Catholic University of Sacred Heart, Rome 00168, Italy
| | - Antonio Grieco
- Department of Medical and Surgical Sciences, CEMAD, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome 00168, Italy
- Department of Internal Medicine, Catholic University of Sacred Heart, Rome 00168, Italy
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40
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Hoepner G, Uzun G, Bakchoul T. Rationale Therapie mit Thrombozytenkonzentraten. TRANSFUSIONSMEDIZIN 2023. [DOI: 10.1055/a-1894-1385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Thrombozytenkonzentrate (TK) stellen eine der wichtigsten Therapieoptionen bei der
Aufrechterhaltung der Hämostase bei Thrombozytopenien und
Thrombozytenfunktionsdefekten dar. Ihre Herstellung und Anwendung ist in Deutschland
durch die „Richtlinie zur Gewinnung von Blut und Blutbestandteilen und zur
Anwendung von Blutprodukten“ 1 und die
„Querschnitts-Leitlinien zur Therapie mit Blutkomponenten und
Plasmaderivaten“ 2 geregelt. In diesem
Übersichtartikel werden die wichtigsten praktischen Aspekte der Therapie mit
TKs zusammengefasst.
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41
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Moriyama T, Takami A, Makino M. Rehabilitation intervention safety in patients with malignant lymphoma with low blood cell counts. J Phys Ther Sci 2023; 35:133-138. [PMID: 36744196 PMCID: PMC9889215 DOI: 10.1589/jpts.35.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/09/2022] [Indexed: 02/04/2023] Open
Abstract
[Purpose] We established criteria for patients with malignant lymphoma with low blood counts, who did not meet the criteria to discontinue rehabilitation or the blood transfusion criteria even though they were borderline for discontinuing rehabilitation. We investigated physical symptoms, activities of daily living, and adverse events in patients who were permitted to undergo rehabilitation intervention using the new criteria. [Participants and Methods] Forty-two patients met the criteria to discontinue rehabilitation based on blood data, and the new-criteria group included 153 patients who received permission for rehabilitation from a hematologist despite not meeting the criteria to discontinue rehabilitation. The survey items were Barthel index at the time of admission and discharge and the length of hospital stay. A two-group comparison was performed, and the occurrence of adverse events associated with exercise intervention were investigated. [Results] The length of hospital stay was shortened in the new-criteria group, and the rehabilitation intervention rate improved. [Conclusion] For patients with malignant lymphoma with low blood cell counts, continuing rehabilitation intervention with physician permission may prevent a decline in activities of daily living as well as maintain and improve motor function.
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Affiliation(s)
- Takeshi Moriyama
- Department of Rehabilitation, Hakodate Municipal Hospital,
Japan, Hirosaki University Graduate School of Health Sciences:
66-1 Hontyou, Hirosaki-shi, Aomori 036-8564, Japan
| | - Akiyoshi Takami
- Hirosaki University Graduate School of Health Sciences:
66-1 Hontyou, Hirosaki-shi, Aomori 036-8564, Japan,Corresponding author. Akiyoshi Takami (E-mail: )
| | - Misato Makino
- Hirosaki University Graduate School of Health Sciences:
66-1 Hontyou, Hirosaki-shi, Aomori 036-8564, Japan
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42
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Diaz C, Quintero JA, Zarama V, Bustamante-Cristancho LA. Bleeding Complications in Uremic Patients After Ultrasound-Guided Central Venous Catheter Placement. Open Access Emerg Med 2023; 15:21-28. [PMID: 36660271 PMCID: PMC9843503 DOI: 10.2147/oaem.s384081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 12/09/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Bleeding associated with elevated blood urea nitrogen (BUN) is a known complication. Patients with uremia require a central venous catheter insertion by dialysis. The relation between BUN and bleeding complications during central venous catheter insertion is not yet clear. Objective We described the frequency of complications associated with central venous catheter implantation in uremic patients and evaluated the statistical relationship between bleeding complications and catheter type, number of punctures, and catheter insertion site. Also, we determined if any value of BUN is associated with bleeding complications. Methods We included patients with a serum value of BUN >70 mg/dl that required insertion of a central venous catheter. The quantitative variables were expressed through the measure of central tendency. A bivariate analysis and a ROC curve were performed. Results A total of 273 catheters were included in this study. Bleeding complications were detected in 69 cases (25.3%), and local bleeding was the most frequent complication in 51/69 cases. Statistically significant association was not established. We did not find a specific cut-off value directly related to BUN levels and the rate of complications. Conclusion Bleeding complications associated with the insertion of central venous catheter and the suspected disorder of hemostasis given by BUN levels >70 mg/dl are common. It was not possible to determine a BUN cut-off value to predict complications. The association analysis was not conclusive. High BUN levels should not be considered a high-risk condition for central venous cannulation under ultrasound guidance performed by trained personnel.
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Affiliation(s)
- Carime Diaz
- Critical Medicine, Emergency Department, Fundación Valle del Lili, Cali, 760032, Colombia
| | - Jaime A Quintero
- Critical Medicine, Emergency Department, Fundación Valle del Lili, Cali, 760032, Colombia,Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, 760032, Colombia,Correspondence: Jaime A Quintero, Critical Medicine, Emergency Department, Centro de Investigaciones Clínicas, Fundación Valle del Lili, Carrera 98 No. 18-49, Cali, 760032, Colombia, Tel +57 3184257759, Email
| | - Virginia Zarama
- Critical Medicine, Emergency Department, Fundación Valle del Lili, Cali, 760032, Colombia
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43
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Swartz S, Puetz JR, Madenberg D, Voigt L, Cuzovic N, Bielecki M, Umpierrez De Reguero A. Bone marrow biopsies: A hospitalist bedside procedure service 5-year experience. J Hosp Med 2023; 18:15-20. [PMID: 36238982 DOI: 10.1002/jhm.12983] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 08/31/2022] [Accepted: 09/14/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Bone marrow aspiration and biopsies (BMAB) are a relatively frequent procedure needed in the inpatient setting, especially in a tertiary care center. OBJECTIVE Procedure-focused hospitalists can provide an excellent option for doing inpatient BMAB. Here we present five years of experience with a hospitalist bedside procedure service (BPS) performing BMAB. DESIGN In 2016, the BPS partnered with the oncology service to begin performing inpatient BMAB. SETTINGS AND PARTICIPANTS We evaluated internally collected data from the procedures performed by the BPS from 2016-2020. INTERVENTION From 2015-2016, faculty members on the BPS team were trained by the oncology department to do a BMAB, which was then offered as an inpatient procedure by the BPS from 2016-2021. MAIN OUTCOME AND MEASURES Total number of BMAB performed, success rates, bleeding risk profiles of patients, rate of trainee participation, and complication rates. RESULTS The BPS performed a total of 432 BMAB from 2016-2021. Forty-six (10.6%) were unsuccessful and required referral for CT guidance. Elevated bleeding risk was present in 88 (20.4%) of patients. Trainees assisted in 62 (14.4%) of the procedures.There was one complication (0.2%).
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Affiliation(s)
- Sheila Swartz
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joseph R Puetz
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Devin Madenberg
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lara Voigt
- Department of Medicine, UT Health San Antonio, San Antonio, Texas, USA
| | - Nikola Cuzovic
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Matthew Bielecki
- Department of Medicine, Apogee Physicians Medical Group, Milwaukee, Wisconsin, USA
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Avau B, O D, Veys K, Georgsen J, Nahirniak S, Shehata N, Stanworth SJ, Van Remoortel H, De Buck E, Compernolle V, Vandekerckhove P. Systematic reviews on platelet transfusions: Is there unnecessary duplication of effort? A scoping review. Vox Sang 2023; 118:16-23. [PMID: 36454598 PMCID: PMC10107266 DOI: 10.1111/vox.13387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 11/03/2022] [Accepted: 11/18/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND AND OBJECTIVES Platelet transfusions are used across multiple patient populations to prevent and correct bleeding. This scoping review aimed to map the currently available systematic reviews (SRs) and evidence-based guidelines in the field of platelet transfusion. MATERIALS AND METHODS A systematic literature search was conducted in seven databases for SRs on effectiveness (including dose and timing, transfusion trigger and ratio to other blood products), production modalities and decision support related to platelet transfusion. The following data were charted: methodological features of the SR, population, concept and context features, outcomes reported, study design and number of studies included. Results were synthesized in interactive evidence maps. RESULTS We identified 110 SRs. The majority focused on clinical effectiveness, including prophylactic or therapeutic transfusions compared to no platelet transfusion (34 SRs), prophylactic compared to therapeutic-only transfusion (8 SRs), dose, timing (11 SRs) and threshold for platelet transfusion (15 SRs) and the ratio of platelet transfusion to other blood products in massive transfusion (14 SRs). Furthermore, we included 34 SRs on decision support, of which 26 evaluated viscoelastic testing. Finally, we identified 22 SRs on platelet production modalities, including derivation (4 SRs), pathogen inactivation (6 SRs), leucodepletion (4 SRs) and ABO/human leucocyte antigen matching (5 SRs). The SRs were mapped according to concept and clinical context. CONCLUSION An interactive evidence map of SRs and evidence-based guidelines in the field of platelet transfusion has been developed and identified multiple reviews. This work serves as a tool for researchers looking for evidence gaps, thereby both supporting research and avoiding unnecessary duplication.
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Affiliation(s)
- Bert Avau
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Dorien O
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Koen Veys
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium
| | - Jørgen Georgsen
- South Danish Transfusion Service & Tissue Center, Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Susan Nahirniak
- Faculty of Medicine, University of Alberta, Edmonton, Canada.,Transfusion and Transplantation Medicine, Alberta Precision Laboratories, Calgary, Alberta, Canada
| | - Nadine Shehata
- Departments of Medicine, Laboratory Medicine and Pathobiology, Institute of Health Policy Management and Evaluation, University of Toronto, Mount Sinai Hospital, Toronto, Canada
| | - Simon J Stanworth
- Transfusion Medicine, NHS Blood and Transplant, Oxford, UK.,Radcliffe Department of Medicine, University of Oxford, and NIHR Oxford Biomedical Research Centre, Oxford, UK.,Department of Haematology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Hans Van Remoortel
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Emmy De Buck
- Centre for Evidence-Based Practice, Belgian Red Cross, Mechelen, Belgium.,Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium
| | - Veerle Compernolle
- Blood Services, Belgian Red Cross, Mechelen, Belgium.,Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Philippe Vandekerckhove
- Department of Public Health and Primary Care, Leuven Institute for Healthcare Policy, KU Leuven, Leuven, Belgium.,Belgian Red Cross, Mechelen, Belgium.,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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45
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Yasui Y, Kato H, Oda T, Nakamura M, Morita A. Complications and risk factors of punch biopsy: A retrospective large-scale study. J Dermatol 2023; 50:98-101. [PMID: 36151785 DOI: 10.1111/1346-8138.16585] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 08/24/2022] [Accepted: 09/05/2022] [Indexed: 01/04/2023]
Abstract
The authors analyzed the risk factors of punch biopsy by investigating the complications of the technique and their proportions. Patients who underwent punch biopsy in a dermatology clinic between November 2018 and November 2020 (n = 1294; mean age, 62.3 years; 540 men and 754 women) were enrolled in the current study. The most common complication was postoperative bleeding (0.9%). Wound infection (0.2%), surrounding skin damage (0.2%), and vagal reflex (0.1%) were also observed. The main risk factors for bleeding following biopsy were location of biopsy site outside of the trunk (odds ratio [OR], 4.60 [95% CI, 2.65-8.00]; p < 0.001) and platelet count lower than 150 000/μL (OR, 2.82 [95% CI, 1.69-4.73]; p < 0.001). When performing a punch biopsy, an adequate explanation of the risks and complications should be provided before obtaining informed consent. Further, blood sampling tests should be performed in advance and the types of cases that may require wound suture should be appropriately determined.
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Affiliation(s)
- Yukiko Yasui
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takao Oda
- Department of Dermatology, Kainan Hospital, Yatomi, Japan
| | - Motoki Nakamura
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Akimichi Morita
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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46
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Critical conversations on patient blood management with clinical colleagues. Transfus Apher Sci 2022; 61:103597. [DOI: 10.1016/j.transci.2022.103597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Wang L, Ji K, Chen L, Li Y, Zhu W, Yuan X, Bao X, Wu X, He J. Posttransplant de novo DSA and NDSA affect GvHD, OS, and DFS after haplo-HSCT in patients without pre-existing HLA antibodies of hematological malignancies. Front Immunol 2022; 13:1047200. [PMID: 36532004 PMCID: PMC9751004 DOI: 10.3389/fimmu.2022.1047200] [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: 09/17/2022] [Accepted: 11/08/2022] [Indexed: 12/03/2022] Open
Abstract
To examine the production time, type, and MFI of post-transplantation de novo HLA antibodies, and their effects on haplo-HSCT outcomes, we retrospectively included 116 patients who were negative for pre-existing HLA antibodies. In total, 322 serum samples from pre-transplantation to post-transplantation were dynamically tested by Luminex and single-antigen bead reagents. Patients were divided into: HLA antibody persistently negative group (group 1), the de novo HLA antibody transiently positive group (group 2), the de novo HLA antibody non-persistently positive group (group 3), and the de novo HLA antibody persistently positive group (group 4). Group 4 included DSA+non-DSA (NDSA) (group 4a) and NDSA (group 4b) groups. The detection rate of de novo HLA antibodies was 75.9% (88/116). The median MFI for de novo HLA antibodies was 2439 (1033-20162). The incidence of II-IV aGvHD was higher in group 2 than in group 1 (52.6% vs 17.9%, P < 0.01); in group 4a than in group 1 (87.5% vs 17.9%, P < 0.001); and in group 4a than in group 4b (87.5% vs 40.0%, P = 0.001). The DFS (37.5% vs 85.7%, P < 0.01) and OS (37.5% vs 85.7%, P < 0.01) of group 4a were lower than those of group 1. The DFS (48.0% vs 85.7%, P < 0.01) and OS (56.0% vs 85.7%, P = 0.03) of group 4b were lower than those of group 1. Multivariate analysis showed that de novo HLA antibody being transiently positive (HR: 5.30; 95% CI: 1.71-16.42, P = 0.01) and persistently positive (HR: 5.67; 95% CI: 2.00-16.08, P < 0.01) were both associated with a higher incidence of II-IV aGvHD. Persistently positive de novo HLA antibodies were a risk factor for reduced DFS (HR: 6.57; 95% CI: 2.08-20.70, P < 0.01) and OS (HR: 5.51; 95% CI: 1.73-17.53, P < 0.01). DSA and NDSA can be detected since 15 days after haplo-HSCT in patients without pre-existing HLA antibodies, and affect aGvHD, DFS, and OS. Haplo-HSCT patients must be monitored for HLA antibodies changes for appropriate preventive clinical management, and we recommend that 1-month post-transplantation is the best test time point.
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Affiliation(s)
- Lan Wang
- HLA Laboratory of Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,Department of Hematology, Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Kai Ji
- HLA Laboratory of Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Luyao Chen
- HLA Laboratory of Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Ying Li
- HLA Laboratory of Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,Department of Hematology, Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Wenjuan Zhu
- HLA Laboratory of Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,Department of Hematology, Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiaoni Yuan
- HLA Laboratory of Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiaojing Bao
- HLA Laboratory of Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Xiaojin Wu
- Department of Hematology, Jiangsu Institute of Hematology, First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China
| | - Jun He
- HLA Laboratory of Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, Jiangsu, China,*Correspondence: Jun He,
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48
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Wang TF, Sanfilippo KM, Douketis J, Falanga A, Karageorgiou J, Maraveyas A, Ortel TL, Soff G, Vedantham S, Zwicker JI. Peri-procedure management of antithrombotic agents and thrombocytopenia for common procedures in oncology: Guidance from the SSC of the ISTH. J Thromb Haemost 2022; 20:3026-3038. [PMID: 36217296 DOI: 10.1111/jth.15896] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/31/2022] [Accepted: 09/23/2022] [Indexed: 01/13/2023]
Abstract
Patients with cancer have an increased risk of thrombosis requiring anticoagulants and/or antiplatelet agents, and they can also encounter thrombocytopenia due to cancer itself or cancer therapies. They often undergo many procedures such as tissue or bone marrow biopsies, placement of central access lines, diagnostic or therapeutic draining procedures, lumbar puncture, and more. Management of antithrombotic agents or thrombocytopenia around the time of these procedures is highly variable. In this document, the Hemostasis and Malignancy Subcommittee of the International Society on Thrombosis and Haemostasis aims to provide useful practice guidance in the management of antithrombotic agents and thrombocytopenia around the time of common procedures in patients with cancer.
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Affiliation(s)
- Tzu-Fei Wang
- Department of Medicine, University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Kristen M Sanfilippo
- Division of Hematology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - James Douketis
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anna Falanga
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
- Department of Immunohematology and Transfusion Medicine, Hospital Papa Giovanni XXIII, Bergamo, Italy
| | - John Karageorgiou
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | | | - Thomas L Ortel
- Division of Hematology, Department of Medicine, Duke University, Durham, North Carolina, USA
- Department of Pathology, Duke University, Durham, North Carolina, USA
| | - Gerald Soff
- Division of Hematology, University of Miami Health System/Sylvester Comprehensive Cancer Center, Miami, Florida, USA
| | - Suresh Vedantham
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, Saint Louis, Missouri, USA
| | - Jeffrey I Zwicker
- Division of Hemostasis and Thrombosis, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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49
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Thrombocytopenia in Patients With Myelofibrosis: A Practical Management Guide. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e1067-e1074. [PMID: 36117043 DOI: 10.1016/j.clml.2022.08.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 01/26/2023]
Abstract
Patients with myelofibrosis (MF) frequently develop thrombocytopenia as a consequence of bone marrow fibrosis, splenic sequestration, and myelosuppression from an inflammatory microenvironmental milieu. Thrombocytopenia occurs frequently at diagnosis, worsens with disease progression, is an independent adverse prognostic factor, and limits effective dosing of JAK2 inhibitors. Recently, pacritinib was approved for patients with MF and extreme thrombocytopenia. However, this JAK2/IRAK1 inhibitor is not primarily used to attain improvement in platelet count. In this narrative review, we discuss strategies to specifically address thrombocytopenia in MF patients including immunomodulatory drugs, synthetic androgens, hypomethylating agents and splenectomy, all of which have only modest efficacy in alleviating thrombocytopenia. We also detail transfusion approaches, including diagnostic and therapeutic consideration for platelet transfusion refractoriness. We end by discussing novel therapies, including TGFβ traps and recombinant pentraxin-2, which may increase platelet counts in MF patients. Despite recent therapeutic advancements in MF, there remains a near paucity of agents that can effectively alleviate thrombocytopenia.
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50
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Xie S, Jiang C, Wu M, Ye Y, Wu B, Sun X, Lv X, Chen R, Yu W, Sun Q, Wu Y, Que R, Li H, Yang L, Liu W, Zuo J, Jensen LD, Huang G, Cao Y, Yang Y. Dietary ketone body-escalated histone acetylation in megakaryocytes alleviates chemotherapy-induced thrombocytopenia. Sci Transl Med 2022; 14:eabn9061. [PMID: 36449600 DOI: 10.1126/scitranslmed.abn9061] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Chemotherapy-induced thrombocytopenia (CIT) is a severe complication in patients with cancer that can lead to impaired therapeutic outcome and survival. Clinically, therapeutic options for CIT are limited by severe adverse effects and high economic burdens. Here, we demonstrate that ketogenic diets alleviate CIT in both animals and humans without causing thrombocytosis. Mechanistically, ketogenic diet-induced circulating β-hydroxybutyrate (β-OHB) increased histone H3 acetylation in bone marrow megakaryocytes. Gain- and loss-of-function experiments revealed a distinct role of 3-β-hydroxybutyrate dehydrogenase (BDH)-mediated ketone body metabolism in promoting histone acetylation, which promoted the transcription of platelet biogenesis genes and induced thrombocytopoiesis. Genetic depletion of the megakaryocyte-specific ketone body transporter monocarboxylate transporter 1 (MCT1) or pharmacological targeting of MCT1 blocked β-OHB-induced thrombocytopoiesis in mice. A ketogenesis-promoting diet alleviated CIT in mouse models. Moreover, a ketogenic diet modestly increased platelet counts without causing thrombocytosis in healthy volunteers, and a ketogenic lifestyle inversely correlated with CIT in patients with cancer. Together, we provide mechanistic insights into a ketone body-MCT1-BDH-histone acetylation-platelet biogenesis axis in megakaryocytes and propose a nontoxic, low-cost dietary intervention for combating CIT.
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Affiliation(s)
- Sisi Xie
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China.,Longyan First Hospital Affiliated to Fujian Medical University, Longyan 364000, China
| | - Chenyu Jiang
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Meng Wu
- Longyan First Hospital Affiliated to Fujian Medical University, Longyan 364000, China
| | - Ying Ye
- Department of Oral Implantology, Stomatological Hospital and Dental School of Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai 200072, China
| | - Biying Wu
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Xiaoting Sun
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China.,Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 65 Solna, Sweden.,Oujiang Laboratory (Zhejiang Lab for Regenerative Medicine, Vison and Brain Health), School of Pharmaceutical Science, Wenzhou Medical University, Wenzhou 325024, China
| | - Xue Lv
- State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology and Blood Diseases Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Tianjin 300020, China
| | - Ruibo Chen
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Wen Yu
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Qi Sun
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Yuting Wu
- Longyan First Hospital Affiliated to Fujian Medical University, Longyan 364000, China
| | - Rongliang Que
- Longyan First Hospital Affiliated to Fujian Medical University, Longyan 364000, China
| | - Huilan Li
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China.,Longyan First Hospital Affiliated to Fujian Medical University, Longyan 364000, China
| | - Ling Yang
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Wen Liu
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Ji Zuo
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Lasse D Jensen
- Department of Health, Medical and Caring Sciences, Division of Cardiovascular Medicine, Linköping University, 581 83 Linköping, Sweden
| | - Guichun Huang
- Medical Oncology Department of Jinling Hospital, Medical School of Nanjing University, Nanjing 200002, China
| | - Yihai Cao
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, 171 65 Solna, Sweden
| | - Yunlong Yang
- Department of Cellular and Genetic Medicine, School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
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