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Vrielink H, Le Poole K, Stegmayr B, Kielstein J, Berlin G, Ilhan O, Seval GC, Prophet H, Aandahl A, Deeren D, Bojanic I, Blaha M, Lanska M, Gasova Z, Bhuiyan-Ludvikova Z, Blahutova S, Hrdlickova R, Audzijoniene J, Griskevicius A, Glatt T, Strineholm V, Ott M, Nilsson T, Newman E, Derfler K, Witt V, Toss F. The world apheresis association registry, 2023 update. Transfus Apher Sci 2023; 62:103831. [PMID: 37827962 DOI: 10.1016/j.transci.2023.103831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
The WAA apheresis registry contains data on more than 140,000 apheresis procedures conducted in 12 different countries. The aim is to give an update of indications, type and number of procedures and adverse events (AEs). MATERIAL AND METHODS: The WAA-registry is used for registration of apheresis procedures and is free of charge. The responsible person for a center can apply at the site www.waa-registry.org RESULTS: Data includes reported AEs from 2012 and various procedures and diagnoses during the years 2018-2022; the latter in total from 27 centers registered a total of 9500 patients (41% women) that began therapeutic apheresis (TA) during the period. A total of 58,355 apheresis procedures were performed. The mean age was 50 years (range 0-94). The most common apheresis procedure was stem cell collection for which multiple myeloma was the most frequent diagnosis (51%). Donor cell collection was done in 14% and plasma exchange (PEX) in 28% of patients; In relation to all performed procedures PEX, using a centrifuge (35%) and LDL-apheresis (20%) were the most common. The main indication for PEX was TTP (17%). Peripheral veins were used in 56% as the vascular access. The preferred anticoagulant was ACD. AEs occurred in 2.7% of all procedures and were mostly mild (1%) and moderate 1.5% (needed supportive medication) and, only rarely, severe (0.15%). CONCLUSION: The data showed a wide range of indications and variability in apheresis procedures with low AE frequency.
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Affiliation(s)
- Hans Vrielink
- Unit of Transfusion medicine of Sanquin Blood Supply, Sanquin Blood Supply Foundation in Amsterdam, the Netherlands
| | - Kaatje Le Poole
- Unit of Transfusion medicine of Sanquin Blood Supply, Sanquin Blood Supply Foundation in Amsterdam, the Netherlands
| | - Bernd Stegmayr
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
| | - Jan Kielstein
- Academic Teaching Hospital Braunschweig, Medical Clinic V - Nephrology, Rheumatology, Blood Purification, Germany
| | - Gösta Berlin
- Department of Clinical Immunology and Transfusion Medicine, and Department of Biochemical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Osman Ilhan
- Department Haematology, University Hospital, Ankara, Turkey
| | | | | | - Astrid Aandahl
- Dep of Immunology and Transfusion Medicine, Akershus University Hospital, Lorenskog, Norway
| | | | - Ines Bojanic
- Clinical Department of Transfusion Medicine and Transplantation Biology, University Hospital Centre Zagreb, Croatia
| | - Milan Blaha
- IV. Internal Hematological Klinik, Fakultni Nemocnice, Hradec Králové, Czech Republic
| | - Miriam Lanska
- IV. Internal Hematological Klinik, Fakultni Nemocnice, Hradec Králové, Czech Republic
| | - Zdenka Gasova
- Apheresis Department, Institute of Hematology and Blood Transfusion, Prague, Czech Republic
| | | | - Sarka Blahutova
- Blood Centre, University Hospital Ostrava, Ostrava, Czech Republic
| | | | - Judita Audzijoniene
- Therapeutic apheresis unit, Vilnius university hospital Santariskiu clinics, Vilnius, Lithuania
| | - Antanas Griskevicius
- Therapeutic apheresis unit, Vilnius university hospital Santariskiu clinics, Vilnius, Lithuania
| | - Tanya Glatt
- South African National Blood Service, Johannesburg, South Africa
| | | | - Michael Ott
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Thomas Nilsson
- Department of Nephrology, University Hospital, Uppsala, Sweden
| | - Elizabeth Newman
- Bone Marrow Transplant & Apheresis, Apheresis & Cell Therapies Unit, Concord Repatriation General Hospital, Concord, NSW, Australia
| | - Kurt Derfler
- The Institute for the Diagnosis and Therapy of Atherosclerosis and Fat Metabolism Disorders, Athos, Vienna, Austria
| | - Volker Witt
- St. Anna Kinderspital, University Hospital, Vienna, Austria
| | - Fredrik Toss
- Department of Clinical Microbiology, Division of Clinical Immunology, Umeå University, Umeå, Sweden
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Moss TT, Stavem K, Aandahl A, Gløersen AS, Grønberg BH, Neumann K, Vedeler CA, Lundqvist C. Case Report: Limbic encephalitis following treatment with durvalumab for small-cell lung cancer. Front Immunol 2023; 14:1278761. [PMID: 37908347 PMCID: PMC10613972 DOI: 10.3389/fimmu.2023.1278761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/29/2023] [Indexed: 11/02/2023] Open
Abstract
Background Durvalumab is an immune checkpoint Inhibitor (ICIs) that is used in the treatment of malignant tumors, such as lung cancer and melanoma. ICIs are associated with immune-related adverse events including autoimmune encephalitis, although both paraneoplastic phenomena and ICI treatment may lead to autoimmunity. Case presentation We describe a 72-year old male patient with small-cell lung cancer, who during adjuvant treatment with Durvalumab developed GABABR1 and GAD65 antibodies and both diabetes and autoimmune limbic encephalitis. Because he was followed prospectively as part of a treatment study, we had access to repeated serum samples and cognitive assessments over time prior to developing encephalitis and diabetes, in addition to later assessments. A high titer of GABABR1 antibodies appeared early, while GAD65 antibodies appeared later with a lower titer in parallel with the development of diabetes. As he subsequently developed clinical signs of encephalitis, verified by EEG and brain MRI, he also had CSF GABABR1 antibodies. Durvalumab was discontinued and steroid treatment with subsequent plasmapheresis were started, resulting in reduction of both CSF and serum antibody levels. Clinical signs of encephalitis gradually improved. Conclusion This case illustrates the importance of being aware of possible serious autoimmune adverse reactions, including neurological syndromes such as encephalitis, when treating patients with high risk of para-neoplasia with ICIs. In addition, the case shows the development of autoantibodies over time.
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Affiliation(s)
- Thomas T. Moss
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Knut Stavem
- Pulmonary Department, Akershus University Hospital, Lørenskog, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Astrid Aandahl
- Department of Immunology and Transfusion Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Anne S. Gløersen
- Pulmonary Department, Akershus University Hospital, Lørenskog, Norway
| | - Bjørn H. Grønberg
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Oncology, St. Olavs Hospital, Trondheim, Norway
| | - Kirill Neumann
- Pulmonary Department, Akershus University Hospital, Lørenskog, Norway
| | - Christian A. Vedeler
- Department of Neurology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christofer Lundqvist
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Espinosa A, Aandahl A, Arsenovic MG, Sundic T, Hervig T, Jacobsen B, Kristoffersen G, Holtan A, Detlie TE. Evidensbasert transfusjonspraksis ved jernmangelanemi. Tidsskr Nor Laegeforen 2023; 143:22-0443. [PMID: 37254973 DOI: 10.4045/tidsskr.22.0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
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Stegmayr B, Newman E, Witt V, Derfler K, Leitner G, Eloot S, Dhondt A, Deeren D, Ptak J, Blaha M, Lanska M, Gasova Z, Bhuiyan-Ludvikova Z, Hrdlickova R, Ramlow W, Prophet H, Kielstein JT, Liumbruno G, Mori E, Griskevicius A, Audzijoniene J, Vrielink H, Rombout-Sestrienkova E, Aandahl A, Sikole A, Tomaz J, Lalic K, Bojanic I, Strineholm V, Brink B, Berlin G, Dykes J, Nilsson T, Eich T, Hadimeri H, Welander G, Ortega Sanchez S, Ilhan O, Poole C. Using the World Apheresis Association Registry Helps to Improve the Treatment Quality of Therapeutic Apheresis. Transfus Med Hemother 2021; 48:234-239. [PMID: 34539317 DOI: 10.1159/000513123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Accepted: 04/07/2020] [Indexed: 01/20/2023] Open
Abstract
Therapeutic apheresis (TA) is prescribed to patients that suffer from a severe progressive disease that is not sufficiently treated by conventional medications. A way to gain more knowledge about this treatment is usually by the local analysis of data. However, the use of large quality assessment registries enables analyses of even rare findings. Here, we report some of the recent data from the World Apheresis Association (WAA) registry. Data from >104,000 procedures were documented, and TA was performed on >15,000 patients. The main indication for TA was the collection of autologous stem cells (45% of patients) as part of therapy for therapy. Collection of stem cells from donors for allogeneic transplantation was performed in 11% of patients. Patients with indications such as neurological diseases underwent plasma exchange (28%). Extracorporeal photochemotherapy, lipid apheresis, and antibody removal were other indications. Side effects recorded in the registry have decreased significantly over the years, with approximately only 10/10,000 procedures being interrupted for medical reasons. Conclusion Collection of data from TA procedures within a multinational and multicenter concept facilitates the improvement of treatment by enabling the analysis of and feedback on indications, procedures, effects, and side effects.
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Affiliation(s)
- Bernd Stegmayr
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Elizabeth Newman
- Bone Marrow Transplant and Apheresis, Concord, New South Wales, Australia
| | - Volker Witt
- St. Anna, Pediatric Department, Vienna, Austria
| | | | - Gerda Leitner
- Apheresis Unit, Haematological, AKH, Vienna, Austria
| | - Sunny Eloot
- Department of Nephrology, University Hospital, Ghent, Belgium
| | | | - Dries Deeren
- Department of Hematology, AZ Delta, Roeselare, Belgium
| | - Jan Ptak
- Transfusion Medicine, Frydek-Mistek, Czechia
| | - Milan Blaha
- Hemapheretic Center of the 3rd Department of Medicine, Medical Faculty and University Hospital, Hradec Kralove, Czechia
| | - Mirka Lanska
- Hemapheretic Center of the 3rd Department of Medicine, Medical Faculty and University Hospital, Hradec Kralove, Czechia
| | - Zdenka Gasova
- Institute of Hematology and Blood Transfusion, Prague, Czechia
| | | | | | | | | | - Jan T Kielstein
- Nephrology, Rheumatology, Blood Purification, Academic Teaching Hospital, Braunschweig, Germany
| | | | | | | | | | | | | | - Astrid Aandahl
- Center for Immunology and Transfusion, Akers University Hospital, Loerenskog, Norway
| | - Aleksandar Sikole
- Department of Nephrology, University Hospital, Skopje, North Macedonia
| | - Jorge Tomaz
- Apheresis Unit, Coimbra University Hospital, Coimbra, Portugal
| | - Katarina Lalic
- Institute for Endocrinology, University Hospital, Belgrade, Serbia
| | - Ines Bojanic
- Transfusion Medicine and Transplantation Biology, University, Zagreb, Croatia
| | | | - Bo Brink
- Department of Nephrology, University Hospital, Huddinge, Sweden
| | - Gösta Berlin
- Clinical Immunology and Transfusion Medicine, Linköping University, Linköping, Sweden
| | | | - Thomas Nilsson
- Department of Nephrology, University Hospital, Uppsala, Sweden
| | - Torsten Eich
- Blood Center, University, Uppsala, Sweden, Uppsala, Sweden
| | - Henrik Hadimeri
- Department of Nephrology, Skaraborg Hospital, Skövde, Sweden
| | | | | | - Osman Ilhan
- Department Haematology, University Hospital, Ankara, Turkey
| | - Colwyn Poole
- South African National Blood Service, Johannesburg, South Africa
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Zeller MP, Barty R, Aandahl A, Apelseth TO, Callum J, Dunbar NM, Elahie A, Garritsen H, Hancock H, Kutner JM, Manukian B, Mizuta S, Okuda M, Pagano MB, Pogłód R, Rushford K, Selleng K, Sørensen CH, Sprogøe U, Staves J, Weiland T, Wendel S, Wood EM, van de Watering L, van Wordragen‐Vlaswinkel M, Ziman A, Jan Zwaginga J, Murphy MF, Heddle NM, Yazer MH. An international investigation into O red blood cell unit administration in hospitals: the GRoup O Utilization Patterns (GROUP) study. Transfusion 2017; 57:2329-2337. [DOI: 10.1111/trf.14255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 05/11/2017] [Accepted: 05/14/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Michelle P. Zeller
- McMaster Centre for Transfusion ResearchMcMaster UniversityHamilton Ontario Canada
- Canadian Blood ServicesAncaster Ontario Canada
| | - Rebecca Barty
- McMaster Centre for Transfusion ResearchMcMaster UniversityHamilton Ontario Canada
| | | | | | - Jeannie Callum
- Sunnybrook Health Sciences Centre, Department of Laboratory Medicine and Pathobiology, University of TorontoToronto Ontario Canada
| | | | | | - Henk Garritsen
- Institute for Clinical Transfusion MedicineMunicipal Hospital Braunschweig
- Helmholtz Centre for Infection ResearchBraunschweig Germany
| | - Helen Hancock
- UC Health, University of Cincinnati Medical CenterCincinnati Ohio
| | | | - Belinda Manukian
- UF Health Shands HospitalUniversity of FloridaGainsville Florida
| | | | | | | | - Ryszard Pogłód
- Institute of Hematology and Transfusion MedicineWarsaw Poland
| | | | | | | | - Ulrik Sprogøe
- South Danish Transfusion Service & Tissue CenterOdense University HospitalOdense Denmark
| | - Julie Staves
- Oxford University Hospitals NHS Foundation TrustOxford United Kingdom
| | | | | | | | | | - Maria van Wordragen‐Vlaswinkel
- Leiden University Medical Center and Center for Clinical Transfusion ResearchSanquin Research, and the Department of Immunohematology and Blood Transfusion, Leiden University Medical CenterLeiden The Netherlands
| | - Alyssa Ziman
- Wing‐Kwai and Alice Lee‐Tsing Chung Transfusion Service, Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California at Los AngelesLos Angeles, California
| | - Jaap Jan Zwaginga
- Leiden University Medical Center and Center for Clinical Transfusion ResearchSanquin Research, and the Department of Immunohematology and Blood Transfusion, Leiden University Medical CenterLeiden The Netherlands
| | - Michael F. Murphy
- Oxford University Hospitals NHS Foundation TrustOxford United Kingdom
| | - Nancy M. Heddle
- McMaster Centre for Transfusion ResearchMcMaster UniversityHamilton Ontario Canada
| | - Mark H. Yazer
- University of Pittsburgh and the Institute for Transfusion MedicinePittsburgh Pennsylvania
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Espinosa A, Arsenovic M, Hervig T, Sundic T, Aandahl A, Kronborg J, Seghatchian J. Implementing a patient blood management program in Norway: Where to start? Transfus Apher Sci 2016; 54:422-7. [PMID: 27216542 DOI: 10.1016/j.transci.2016.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Norway has recently established a working group to implement a national patient blood management (PBM) program. Although benchmarking regarding blood usage is challenging in Norway due to legal barriers, a survey was sent to different hospitals to identify possible areas to be prioritized in the first phase of the PBM program. Among them, optimizing the patient's hemoglobin level before elective surgery and implementing electronic check-lists for the indication of transfusion when ordering blood products are two measures that may have a considerable impact on blood usage. The results of the survey also showed that patients may receive a red blood cell transfusion at hemoglobin levels that are higher than those internationally recommended. Since there are no national guidelines for the use of blood products, agreement regarding hemoglobin thresholds is essential to reduce variation in transfusion practice. To achieve these goals, the transfusion specialist plays a key role in promoting the principles behind the PBM concept at the local hospital.
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Affiliation(s)
- A Espinosa
- Department of Immunology and Transfusion Medicine, St. Olav's Hospital, Trondheim, Norway.
| | - M Arsenovic
- Division of Immunology and Transfusion Medicine, Department of Laboratory Medicine, University Hospital of North Norway, Tromsø, Norway
| | - T Hervig
- Blood Bank, Haukeland University Hospital, Bergen, Norway
| | - T Sundic
- Department of Immunology and Transfusion Medicine, Haugesund Hospital, Haugesund, Norway
| | - A Aandahl
- Department of Immunology and Transfusion Medicine, Akershus University Hospital, Lørenskog, Norway
| | - J Kronborg
- Department of Immunology and Transfusion Medicine, Innlandet Hospital Trust, Norway
| | - J Seghatchian
- International Consultancy in Blood Components Quality/Safety Improvement, Audit/Inspection & DDR Strategies, London, UK.
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Mörtzell Henriksson M, Newman E, Witt V, Derfler K, Leitner G, Eloot S, Dhondt A, Deeren D, Rock G, Ptak J, Blaha M, Lanska M, Gasova Z, Hrdlickova R, Ramlow W, Prophet H, Liumbruno G, Mori E, Griskevicius A, Audzijoniene J, Vrielink H, Rombout S, Aandahl A, Sikole A, Tomaz J, Lalic K, Mazic S, Strineholm V, Brink B, Berlin G, Dykes J, Toss F, Axelsson CG, Stegmayr B, Nilsson T, Norda R, Knutson F, Ramsauer B, Wahlström A. Adverse events in apheresis: An update of the WAA registry data. Transfus Apher Sci 2016; 54:2-15. [PMID: 26776481 DOI: 10.1016/j.transci.2016.01.003] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Apheresis with different procedures and devices are used for a variety of indications that may have different adverse events (AEs). The aim of this study was to clarify the extent and possible reasons of various side effects based on data from a multinational registry. The WAA-apheresis registry data focus on adverse events in a total of 50846 procedures in 7142 patients (42% women). AEs were graded as mild, moderate (need for medication), severe (interruption due to the AE) or death (due to AE). More AEs occurred during the first procedures versus subsequent (8.4 and 5.5%, respectively). AEs were mild in 2.4% (due to access 54%, device 7%, hypotension 15%, tingling 8%), moderate in 3% (tingling 58%, urticaria 15%, hypotension 10%, nausea 3%), and severe in 0.4% of procedures (syncope/hypotension 32%, urticaria 17%, chills/fever 8%, arrhythmia/asystole 4.5%, nausea/vomiting 4%). Hypotension was most common if albumin was used as the replacement fluid, and urticaria when plasma was used. Arrhythmia occurred to similar extents when using plasma or albumin as replacement. In 64% of procedures with bronchospasm, plasma was part of the replacement fluid used. Severe AEs are rare. Although most reactions are mild and moderate, several side effects may be critical for the patient. We present side effects in relation to the procedures and suggest that safety is increased by regular vital sign measurements, cardiac monitoring and by having emergency equipment nearby.
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Affiliation(s)
| | - E Newman
- Bone Marrow Transplant & Apheresis, New South Wales, Australia
| | - V Witt
- St. Anna, Vienna, Austria
| | | | | | | | | | | | | | - J Ptak
- Frydek-Mistek, Czech Republic
| | - M Blaha
- Hradec Kralove, Czech Republic
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