1
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Cornelissen LL, Kreuger AL, Caram-Deelder C, Huisman MV, Middelburg RA, Kerkhoffs JLH, von dem Borne PA, Beckers EAM, de Vooght KMK, Kuball J, van der Bom JG, Zwaginga JJ. Association between cardiovascular risk factors and intracranial hemorrhage in patients with acute leukemia. Eur J Haematol 2021; 108:310-318. [PMID: 34923665 DOI: 10.1111/ejh.13737] [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] [Received: 11/02/2021] [Revised: 12/14/2021] [Accepted: 12/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Intracranial hemorrhage is seen more frequently in acute leukemia patients compared to the general population. Besides leukemia related risk factors, also risk factors that are present in the general population might contribute to hemorrhagic complications in leukemia patients. Of those, cardiovascular risk factors leading to chronic vascular damage could modulate the occurrence of intracranial hemorrhage in these patients, as during their disease and treatment acute endothelial damage occurs due to factors like thrombocytopenia and inflammation. OBJECTIVES Our aim was to explore if cardiovascular risk factors can predict intracranial hemorrhage in acute leukemia patients. METHODS In a case control study nested in a cohort of acute leukemia patients, including 17 cases with intracranial hemorrhage and 55 matched control patients without intracranial hemorrhage, data on cardiovascular risk factors was collected for all patients. Analyses were performed via conditional logistic regression. RESULTS Pre-existing hypertension and ischemic heart disease in the medical history were associated with intracranial hemorrhage, with an incidence rate ratio of 12.9 (95% confidence interval (CI) 1.5 to 109.2) and 12.1 (95% CI 1.3 to110.7), respectively. CONCLUSION Both pre-existing hypertension and ischemic heart disease seem to be strong predictors of an increased risk for intracranial hemorrhage in leukemia patients.
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Affiliation(s)
- Loes L Cornelissen
- Jon J van Rood Center for Clinical Transfusion Research, LUMC/Sanquin Leiden, The Netherlands.,Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.,Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Aukje L Kreuger
- Jon J van Rood Center for Clinical Transfusion Research, LUMC/Sanquin Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Camila Caram-Deelder
- Jon J van Rood Center for Clinical Transfusion Research, LUMC/Sanquin Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands
| | - Rutger A Middelburg
- Jon J van Rood Center for Clinical Transfusion Research, LUMC/Sanquin Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean Louis H Kerkhoffs
- Jon J van Rood Center for Clinical Transfusion Research, LUMC/Sanquin Leiden, The Netherlands.,Department of Hematology, Haga teaching hospital, Den Haag, The Netherlands
| | | | - Erik A M Beckers
- Department of Hematology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Karen M K de Vooght
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jürgen Kuball
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Johanna G van der Bom
- Jon J van Rood Center for Clinical Transfusion Research, LUMC/Sanquin Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - J J Zwaginga
- Jon J van Rood Center for Clinical Transfusion Research, LUMC/Sanquin Leiden, The Netherlands.,Department of Hematology, Leiden University Medical Center, Leiden, the Netherlands
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2
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Cornelissen LL, Kreuger AL, Caram-Deelder C, Middelburg RA, Kerkhoffs JLH, von dem Borne PA, Beckers EAM, de Vooght KMK, Kuball J, Zwaginga JJ, van der Bom JG. Thrombocytopenia and the effect of platelet transfusions on the occurrence of intracranial hemorrhage in patients with acute leukemia - a nested case-control study. Ann Hematol 2020; 100:261-271. [PMID: 33067700 PMCID: PMC7782440 DOI: 10.1007/s00277-020-04298-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/03/2020] [Indexed: 02/04/2023]
Abstract
We designed a study to describe the incidence of intracranial hemorrhage according to severity and duration of thrombocytopenia and to quantify the associations of platelet transfusions with intracranial hemorrhage in patients with acute leukemia. In this case-control study nested in a cohort of 859 leukemia patients, cases (n = 17) were patients diagnosed with intracranial hemorrhage who were matched with control patients (n = 55). We documented platelet counts and transfusions for seven days before the intracranial hemorrhage in cases and in a “matched” week for control patients. Three measures of platelet count exposure were assessed in four potentially important time periods before hemorrhage. Among these leukemia patients, we observed the cumulative incidence of intracranial hemorrhage of 3.5%. Low platelet counts were, especially in the three to seven days preceding intracranial hemorrhage, associated with the incidence of intracranial hemorrhage, although with wide confidence intervals. Platelet transfusions during the week preceding the hemorrhage were associated with higher incidences of intracranial hemorrhage; rate ratios (95% confidence interval) for one or two platelet transfusions and for more than two transfusions compared with none were 4.04 (0.73 to 22.27) and 8.91 (1.53 to 51.73) respectively. Thus, among acute leukemia patients, the risk of intracranial hemorrhage was higher among patients with low platelet counts and after receiving more platelet transfusions. Especially, the latter is likely due to clinical factors leading to increased transfusion needs.
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Affiliation(s)
- Loes L Cornelissen
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Aukje L Kreuger
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Camila Caram-Deelder
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rutger A Middelburg
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jean Louis H Kerkhoffs
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands
- Department of Hematology, Haga Teaching Hospital, Den Haag, The Netherlands
| | | | - Erik A M Beckers
- Department of Hematology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Karen M K de Vooght
- Central Diagnostic Laboratory, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jürgen Kuball
- Department of Hematology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - J J Zwaginga
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands
- Department of Immunology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johanna G van der Bom
- Jon J van Rood Center for Clinical Transfusion Medicine, Sanquin/LUMC, Leiden, The Netherlands.
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
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3
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Kreuger AL, Haasnoot GW, Somers JAE, Tomson B, van der Bon JG, van Kraaij MGJ, Weller CM. Ensuring HLA-matched platelet support requires an ethnic diverse donor population. Transfusion 2020; 60:940-946. [PMID: 32086954 PMCID: PMC7317777 DOI: 10.1111/trf.15728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 12/22/2019] [Accepted: 12/27/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients refractory for platelet transfusions benefit from human leukocyte antigen (HLA)‐matched platelet transfusions. Differences in ethnic background of patients and donors could hamper the availability of sufficient numbers of HLA‐matched donors for all patients. We evaluated our HLA‐matched donor program and explored the role of ethnic background of patients related to the number of available donors. METHODS We performed a cohort study among consecutive patients who received HLA‐matched platelet concentrates in the Netherlands between 1994 and 2017. The number of available matched donors was determined per patient. Haplotypes were constructed from genotypes with computer software (PyPop). Based on haplotypes, HaploStats, an algorithm from the National Marrow Donor Program, was used to assess the most likely ethnic background for patients with 5 or fewer and 30 or more donors. RESULTS HLA typing was available for 19,478 donors in September 2017. A total of 1206 patients received 12,350 HLA‐matched transfusions. A median of 83 (interquartile range, 18‐266) donors were available per patient. For 95 (10.3%) patients, 5 or fewer donors were available. These patients were more likely to have an African American background, whereas patients with 30 or more donors were more often from Caucasian origin, compared with Caucasian origin for patients with 30 donors. CONCLUSION Adequate transfusion support could be guaranteed for most but not all refractory patients. More non‐Caucasian donors are required to ensure the availability of HLA‐matched donors for all patients in the Netherlands.
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Affiliation(s)
- Aukje L Kreuger
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Geert W Haasnoot
- Department of Immunohaematology and Blood transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith A E Somers
- Unit Transfusion Medicine, Sanquin Blood Bank, Amsterdam, The Netherlands.,Department of Hematology, Erasmus MC Cancer Center, Rotterdam
| | - Bert Tomson
- Unit Transfusion Medicine, Sanquin Blood Bank, Amsterdam, The Netherlands
| | - Johanna G van der Bon
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marian G J van Kraaij
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Unit Transfusion Medicine, Sanquin Blood Bank, Amsterdam, The Netherlands.,Unit Donor Affairs, Sanquin Blood Bank, Amsterdam, The Netherlands
| | - Claudia M Weller
- Unit Transfusion Medicine, Sanquin Blood Bank, Amsterdam, The Netherlands
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4
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Kreuger AL, Mäkelburg AB, Somers JA, Tomson B, Watering LMG, Bom JG, Kraaij MG, Weller CM. HLA‐matched platelet transfusions are effective only in refractory patients with positive HLA antibody screening. Transfusion 2019; 59:3303-3307. [DOI: 10.1111/trf.15530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/04/2019] [Accepted: 07/24/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Aukje L. Kreuger
- Center for Clinical Transfusion Research Sanquin Research Leiden The Netherlands
- Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands
| | - Anja B.U. Mäkelburg
- Unit Transfusion Medicine Sanquin Blood Bank Amsterdam The Netherlands
- Department of Hematology University Medical Center Groningen Groningen The Netherlands
| | - Judith A.E. Somers
- Unit Transfusion Medicine Sanquin Blood Bank Amsterdam The Netherlands
- Department of Hematology Erasmus MC‐Daniel Den Hoed Cancer Center Rotterdam The Netherlands
| | - Bert Tomson
- Unit Transfusion Medicine Sanquin Blood Bank Amsterdam The Netherlands
| | | | - Johanna G. Bom
- Center for Clinical Transfusion Research Sanquin Research Leiden The Netherlands
- Department of Clinical Epidemiology Leiden University Medical Center Leiden The Netherlands
| | - Marian G.J. Kraaij
- Center for Clinical Transfusion Research Sanquin Research Leiden The Netherlands
- Unit Transfusion Medicine Sanquin Blood Bank Amsterdam The Netherlands
- Unit Donor Affairs Sanquin Blood Bank Amsterdam The Netherlands
| | - Claudia M. Weller
- Unit Transfusion Medicine Sanquin Blood Bank Amsterdam The Netherlands
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5
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Ramirez‐Arcos S, McDonald C, Deol P, Kreuger AL, Patel N, Pidcoke H, Prax M, Seltsam A, Stassinopoulos A. Bacterial safety of blood components–a congress review of the ISBT transfusion‐transmitted infectious diseases working party, bacterial subgroup. ACTA ACUST UNITED AC 2019. [DOI: 10.1111/voxs.12483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
| | | | | | | | | | | | | | - Axel Seltsam
- German Red Cross Blood Service NSTOB Springe Germany
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6
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Saris A, Kreuger AL, Ten Brinke A, Kerkhoffs JLH, Middelburg RA, Zwaginga JJ, van der Meer PF. The quality of platelet concentrates related to corrected count increment: linking in vitro to in vivo. Transfusion 2018; 59:697-706. [PMID: 30226275 DOI: 10.1111/trf.14868] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Revised: 05/04/2018] [Accepted: 05/16/2018] [Indexed: 11/27/2022]
Abstract
BACKGROUND Storage of platelet concentrates (PCs) results in reduced recovery and survival of transfused platelets (PLTs). Upon storage PLTs develop storage lesion that can be monitored by several laboratory tests. However, correlation of these descriptive tests with corrected count increments (CCIs), a marker frequently used to establish the effectiveness of PLT transfusions, is limited or unknown. This study investigated to what extent a functional test or a combined in vitro rating score improves the correlation of laboratory tests with 1-hour CCI. STUDY DESIGN AND METHODS PCs were analyzed using six different laboratory tests (n = 123) before transfusion in a prophylactic setting to 74 hematooncologic patients. Linear regression and Spearman correlation were used to determine associations between descriptive (either separately or combined in an in vitro rating score) or functional test results and 1-hour CCIs obtained after transfusion. RESULTS CD62P expression (r = -0.45), annexin V binding (r = -0.36), the updated in vitro rating score (r = 0.50), and PLT responsiveness after thrombin receptor activator for peptide-6 (TRAP) (r = 0.43-0.57) or adenosine diphosphate stimulation (r = 0.11-0.51) significantly correlated to 1-hour CCIs obtained after transfusion, whereas lactate concentration, ThromboLUX score, and thromboelastography measurements did not. The strongest correlations were observed for in vitro rating score and PLT responsiveness after TRAP stimulation and these tests could explain 24 and 33% of the observed variation in 1-hour CCI, respectively. CONCLUSION Combining descriptive markers in one in vitro rating score improved correlation to 1-hour CCI compared to the tests separately. Of all tests investigated, mean PLT responsiveness after TRAP stimulation showed the strongest clinical correlation and was best able to predict the 1-hour CCI.
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Affiliation(s)
- Anno Saris
- Department Immunopathology, Sanquin Research, University of Amsterdam, Amsterdam, the Netherlands.,Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Aukje L Kreuger
- Center for Clinical Transfusion Research, Sanquin Research, Leiden University Medical Center, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Anja Ten Brinke
- Department Immunopathology, Sanquin Research, University of Amsterdam, Amsterdam, the Netherlands.,Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Jean Louis H Kerkhoffs
- Center for Clinical Transfusion Research, Sanquin Research, Leiden University Medical Center, Leiden, the Netherlands
| | - Rutger A Middelburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden University Medical Center, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research, Sanquin Research, Leiden University Medical Center, Leiden, the Netherlands.,Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - Pieter F van der Meer
- Center for Clinical Transfusion Research, Sanquin Research, Leiden University Medical Center, Leiden, the Netherlands
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7
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Kreuger AL, Middelburg RA, Beckers EAM, de Vooght KMK, Zwaginga JJ, Kerkhoffs JLH, van der Bom JG. The identification of cases of major hemorrhage during hospitalization in patients with acute leukemia using routinely recorded healthcare data. PLoS One 2018; 13:e0200655. [PMID: 30110326 PMCID: PMC6093651 DOI: 10.1371/journal.pone.0200655] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Accepted: 06/30/2018] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Electronic health care data offers the opportunity to study rare events, although detecting these events in large datasets remains difficult. We aimed to develop a model to identify leukemia patients with major hemorrhages within routinely recorded health records. METHODS The model was developed using routinely recorded health records of a cohort of leukemia patients admitted to an academic hospital in the Netherlands between June 2011 and December 2015. Major hemorrhage was assessed by chart review. The model comprised CT-brain, hemoglobin drop, and transfusion need within 24 hours for which the best discriminating cut off values were taken. External validation was performed within a cohort of two other academic hospitals. RESULTS The derivation cohort consisted of 255 patients, 10,638 hospitalization days, of which chart review was performed for 353 days. The incidence of major hemorrhage was 0.22 per 100 days in hospital. The model consisted of CT-brain (yes/no), hemoglobin drop of ≥0.8 g/dl and transfusion of ≥6 units. The C-statistic was 0.988 (CI 0.981-0.995). In the external validation cohort of 436 patients (19,188 days), the incidence of major hemorrhage was 0.46 per 100 hospitalization days and the C-statistic was 0.975 (CI 0.970-0.980). Presence of at least one indicator had a sensitivity of 100% (CI 95.8-100) and a specificity of 90.7% (CI 90.2-91.1). The number of days to screen to find one case decreased from 217.4 to 23.6. INTERPRETATION A model based on information on CT-brain, hemoglobin drop and need of transfusions can accurately identify cases of major hemorrhage within routinely recorded health records.
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Affiliation(s)
- Aukje L. Kreuger
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rutger A. Middelburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Erik A. M. Beckers
- Department of Hematology, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Karen M. K. de Vooght
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Immunohaematology and Blood Transfusion, Leiden University Medical Center, Leiden, the Netherlands
| | - Jean-Louis H. Kerkhoffs
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Hematology, Haga Hospital, Den Haag, the Netherlands
| | - Johanna G. van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
- * E-mail:
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8
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van Hoeven LR, Kreuger AL, Roes KC, Kemper PF, Koffijberg H, Kranenburg FJ, Rondeel JM, Janssen MP. Why was this transfusion given? Identifying clinical indications for blood transfusion in health care data. Clin Epidemiol 2018; 10:353-362. [PMID: 29636633 PMCID: PMC5881526 DOI: 10.2147/clep.s147142] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background To enhance the utility of transfusion data for research, ideally every transfusion should be linked to a primary clinical indication. In electronic patient records, many diagnostic and procedural codes are registered, but unfortunately, it is usually not specified which one is the reason for transfusion. Therefore, a method is needed to determine the most likely indication for transfusion in an automated way. Study design and methods An algorithm to identify the most likely transfusion indication was developed and evaluated against a gold standard based on the review of medical records for 234 cases by 2 experts. In a second step, information on misclassification was used to fine-tune the initial algorithm. The adapted algorithm predicts, out of all data available, the most likely indication for transfusion using information on medical specialism, surgical procedures, and diagnosis and procedure dates relative to the transfusion date. Results The adapted algorithm was able to predict 74.4% of indications in the sample correctly (extrapolated to the full data set 75.5%). A kappa score, which corrects for the number of options to choose from, was found of 0.63. This indicates that the algorithm performs substantially better than chance level. Conclusion It is possible to use an automated algorithm to predict the indication for transfusion in terms of procedures and/or diagnoses. Before implementation of the algorithm in other data sets, the obtained results should be externally validated in an independent hospital data set.
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Affiliation(s)
- Loan R van Hoeven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, the Netherlands
| | - Aukje L Kreuger
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - Kit Cb Roes
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter F Kemper
- Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, the Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
| | - Hendrik Koffijberg
- Department of Health Technology & Services Research, MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, the Netherlands
| | - Floris J Kranenburg
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Intensive Care, Leiden University Medical Center, Leiden, the Netherlands
| | - Jan Mm Rondeel
- Department of Clinical Chemistry, Isala, Zwolle, the Netherlands
| | - Mart P Janssen
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.,Transfusion Technology Assessment Department, Sanquin Research, Amsterdam, the Netherlands
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9
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Kreuger AL, Rostgaard K, Middelburg RA, Kerkhoffs JLH, Edgren G, Erikstrup C, Pedersen OB, Titlestad K, Nielsen KR, Ostrowski SR, Voldstedlund M, van der Bom JG, Ullum H, Hjalgrim H. Storage time of platelet concentrates and risk of a positive blood culture: a nationwide cohort study. Transfusion 2017; 58:16-24. [PMID: 29168187 DOI: 10.1111/trf.14401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 09/20/2017] [Accepted: 09/20/2017] [Indexed: 01/28/2023]
Abstract
BACKGROUND Concern of transfusion-transmitted bacterial infections has been the major hurdle to extend shelf life of platelet (PLT) concentrates. We aimed to investigate the association between storage time and risk of positive blood cultures at different times after transfusion. STUDY DESIGN AND METHODS We performed a nationwide cohort study among PLT transfusion recipients in Denmark between 2010 and 2012, as recorded in the Scandinavian Donations and Transfusions (SCANDAT2) database. Linking with a nationwide database on blood cultures (MiBa), we compared the incidence of a positive blood culture among recipients of PLTs stored 6 to 7 days (old) to those receiving fresh PLTs (1-5 days), using Poisson regression models. We considered cumulative exposures in windows of 1, 3, 5, and 7 days. RESULTS A total of 9776 patients received 66,101 PLT transfusions. The incidence rate ratio (IRR) of a positive blood culture the day after transfusion of at least one old PLT concentrate was 0.77 (95% confidence interval [CI], 0.54-1.09) compared to transfusion of fresh PLT concentrates. The incidence rate of a positive blood culture was lower the day after receiving one old compared to one fresh PLT concentrate (IRR, 0.57; 95% CI, 0.37-0.87). Three, 5, or 7 days after transfusion, storage time was not associated with the risk of a positive blood culture. CONCLUSION Storage of buffy coat-derived PLT concentrates in PAS-C up to 7 days seems safe regarding the risk of a positive blood culture. If anything, transfusion of a single old PLT concentrate may decrease this risk the following day.
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Affiliation(s)
- Aukje L Kreuger
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Klaus Rostgaard
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Rutger A Middelburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jean-Louis H Kerkhoffs
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Haga Hospital, Den Haag, the Netherlands
| | - Gustav Edgren
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.,Hematology Center, Karolinska University Hospital, Stockholm, Sweden
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Ole B Pedersen
- Department of Clinical Immunology, Naestved Hospital, Naestved, Denmark
| | - Kjell Titlestad
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Kaspar R Nielsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Immunology, the Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Marianne Voldstedlund
- Department of Infectious Disease Epidemiology, Statens Serum Institut, Copenhagen, Denmark
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Henrik Ullum
- Department of Clinical Immunology, the Blood Bank, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Henrik Hjalgrim
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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10
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Caram-Deelder C, Kreuger AL, Evers D, de Vooght KMK, van de Kerkhof D, Visser O, Péquériaux NCV, Hudig F, Zwaginga JJ, van der Bom JG, Middelburg RA. Association of Blood Transfusion From Female Donors With and Without a History of Pregnancy With Mortality Among Male and Female Transfusion Recipients. JAMA 2017; 318:1471-1478. [PMID: 29049654 PMCID: PMC5817970 DOI: 10.1001/jama.2017.14825] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
IMPORTANCE Transfusion of red blood cells from female donors has been associated with increased mortality in male recipients. OBJECTIVE To quantify the association between red blood cell transfusion from female donors with and without a history of pregnancy and mortality of red blood cell recipients. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study of first-time transfusion recipients at 6 major Dutch hospitals enrolled from May 30, 2005, to September 1, 2015; the final follow-up date was September 1, 2015. The primary analysis was the no-donor-mixture cohort (ie, either all red blood cell transfusions exclusively from male donors, or all exclusively from female donors without a history of pregnancy, or all exclusively from female donors with a history of pregnancy). The association between mortality and exposure to transfusions from ever-pregnant or never-pregnant female donors was analyzed using life tables and time-varying Cox proportional hazards models. EXPOSURES Red blood cell transfusions from ever-pregnant or never-pregnant female donors, compared with red blood cell transfusions from male donors. MAIN OUTCOMES AND MEASURES All-cause mortality during follow-up. RESULTS The cohort for the primary analyses consisted of 31 118 patients (median age, 65 [interquartile range, 42-77] years; 52% female) who received 59 320 red blood cell transfusions exclusively from 1 of 3 types of donors (88% male; 6% ever-pregnant female; and 6% never-pregnant female). The number of deaths in this cohort was 3969 (13% mortality). For male recipients of red blood cell transfusions, all-cause mortality rates after a red blood cell transfusion from an ever-pregnant female donor vs male donor were 101 vs 80 deaths per 1000 person-years (time-dependent "per transfusion" hazard ratio [HR] for death, 1.13 [95% CI, 1.01-1.26]). For receipt of transfusion from a never-pregnant female donor vs male donor, mortality rates were 78 vs 80 deaths per 1000 person-years (HR, 0.93 [95% CI, 0.81-1.06]). Among female recipients of red blood cell transfusions, mortality rates for an ever-pregnant female donor vs male donor were 74 vs 62 per 1000 person-years (HR, 0.99 [95% CI, 0.87 to 1.13]); for a never-pregnant female donor vs male donor, mortality rates were 74 vs 62 per 1000 person-years (HR, 1.01 [95% CI, 0.88-1.15]). CONCLUSIONS AND RELEVANCE Among patients who received red blood cell transfusions, receipt of a transfusion from an ever-pregnant female donor, compared with a male donor, was associated with increased all-cause mortality among male recipients but not among female recipients. Transfusions from never-pregnant female donors were not associated with increased mortality among male or female recipients. Further research is needed to replicate these findings, determine their clinical significance, and identify the underlying mechanism.
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Affiliation(s)
- Camila Caram-Deelder
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Aukje L. Kreuger
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Dorothea Evers
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Immunohaematology and Blood Transfusion, Leiden University Medical Centre, Leiden, the Netherlands
| | - Karen M. K. de Vooght
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Daan van de Kerkhof
- Department of Clinical Chemistry and Haematology, Catharina Hospital, Eindhoven, the Netherlands
| | - Otto Visser
- Department of Haematology, VU Medical Center, Amsterdam, the Netherlands
| | - Nathalie C. V. Péquériaux
- Department of Clinical Chemistry and Haematology, Jeroen Bosch Hospital, ‘s-Hertogenbosch, the Netherlands
| | | | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Immunohaematology and Blood Transfusion, Leiden University Medical Centre, Leiden, the Netherlands
| | - Johanna G. van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rutger A. Middelburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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11
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Kranenburg FJ, Kreuger AL, Arbous MS, Laeijendecker D, van Kraaij MGJ. The effect of World Blood Donor Day on digital information seeking and donor recruitment. Transfusion 2017; 57:2458-2462. [PMID: 28656684 DOI: 10.1111/trf.14228] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND The purpose of World Blood Donor Day (WBDD) is to raise awareness for the importance of blood donation. The aim of this study was to quantify the impact of WBDD on digital information seeking and donor recruitment. STUDY DESIGN AND METHODS Google Trends data were used to quantify seeking behavior on "blood donation" and "blood donor." Differences in relative search volume (RSV) between the 3 weeks surrounding WBDD and the rest of the year were calculated. Second, mean differences in RSV were compared to assess the additional effect of hosting using translated search terms. Third, we compared the period around WBDD with the control period regarding page views of the Sanquin website and Facebook likes and number of newly registered donors in 2016. RESULTS The mean RSV for "blood donation" in the period of interest was 78.6, compared to 72.1 in the control period (difference, 6.5; 95% confidence interval [95% CI], 1.2-11.8). For "blood donor" this was 78.9 compared to 65.9 (difference, 12.9; 95% CI, 8.1-17.8). We found no additional effect of hosting. In the period of interest, the website of Sanquin was visited 6862 times a day and 4293 times in the control period (difference, 2569; 95% CI, 1687-3451). In June 2016, 54.6% (95% CI, 53.0-56.2) more new donors were registered compared to the control period. CONCLUSION An international campaign like WBDD raises the awareness of blood donation and is effective in convincing people to register as blood donors.
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Affiliation(s)
- Floris J Kranenburg
- Center for Clinical Transfusion Research, Sanquin Research Leiden, Leiden University Medical Center, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | - Aukje L Kreuger
- Center for Clinical Transfusion Research, Sanquin Research Leiden, Leiden University Medical Center, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - M Sesmu Arbous
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Intensive Care Medicine, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Marian G J van Kraaij
- Center for Clinical Transfusion Research, Sanquin Research Leiden, Leiden University Medical Center, Leiden, the Netherlands.,Unit Donor Affairs, Sanquin Blood Bank, Amsterdam, the Netherlands.,Unit Transfusion Medicine, Sanquin Blood Bank, Amsterdam, the Netherlands
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12
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Kreuger AL, Middelburg RA, Bank CM, Beckers EA, van Gammeren AJ, Leyte A, Rondeel JM, de Vooght KM, Weerkamp F, Zwaginga JJ, Kerkhoffs JLH, van der Bom JG. Storage time of platelet concentrates and all-cause bacteremia in hematologic patients. Transfusion 2017; 57:2096-2103. [DOI: 10.1111/trf.14194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Aukje L. Kreuger
- Center for Clinical Transfusion Research; Sanquin Research; Leiden
- Department of Clinical Epidemiology; Leiden University Medical Center; Leiden the Netherlands
| | - Rutger A. Middelburg
- Center for Clinical Transfusion Research; Sanquin Research; Leiden
- Department of Clinical Epidemiology; Leiden University Medical Center; Leiden the Netherlands
| | | | | | | | - Anja Leyte
- OLVG Hospital; Amsterdam the Netherlands
| | | | | | | | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research; Sanquin Research; Leiden
- Department of Immunohaematology and Blood Transfusion; Leiden University Medical Center; Leiden the Netherlands
| | - Jean Louis H. Kerkhoffs
- Center for Clinical Transfusion Research; Sanquin Research; Leiden
- Haga Hospital; Den Haag the Netherlands
| | - Johanna G. van der Bom
- Center for Clinical Transfusion Research; Sanquin Research; Leiden
- Department of Clinical Epidemiology; Leiden University Medical Center; Leiden the Netherlands
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13
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Kreuger AL, Middelburg RA, Kerkhoffs JLH, Schipperus MR, Wiersum-Osselton JC, van der Bom JG. Storage medium of platelet transfusions and the risk of transfusion-transmitted bacterial infections. Transfusion 2017; 57:657-660. [PMID: 28144957 DOI: 10.1111/trf.13969] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 10/13/2016] [Accepted: 11/08/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Transfusion-transmitted bacterial infections (TTBIs) are among the most concerning risks of transfusion of platelet (PLT) concentrates. Storage medium influences bacterial growth dynamics and thereby the sensitivity of screening tests for bacterial contamination. STUDY DESIGN AND METHODS The aim of this study was to quantify the association of storage media with the incidence of TTBIs after transfusion of PLT concentrates. In the Netherlands, the choice of storage medium is determined solely by geographic location of the hospital. We compared types of storage medium of all reported cases of TTBIs after transfusion of a PLT concentrate with types of storage medium of all produced PLT concentrates in the Netherlands from 2003 to 2014. RESULTS Fourteen cases of TTBIs were reported, of which 57.1% received a PLT concentrate stored in PLT additive solution (PAS) and 42.9% a PLT concentrate stored in plasma. Of all produced PLT concentrates 22.3% were stored in PAS and 77.7% in plasma. The relative risk of TTBI after transfusion of a PAS-stored PLT concentrate was 4.63 (95% confidence interval [CI], 1.4-16.2) compared to transfusion of a plasma-stored PLT concentrate. The incidence of TTBIs was 22.2 per million (95% CI, 12.1-37.2 per million) transfused buffy coat PLT concentrates. CONCLUSION Transfusion of PAS-stored PLT concentrates is associated with a fourfold increased incidence of TTBIs, compared to plasma-stored PLT concentrates.
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Affiliation(s)
- Aukje L Kreuger
- Center for Clinical Transfusion Research, Sanquin Research, Leiden University Medical Center, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rutger A Middelburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden University Medical Center, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jean-Louis H Kerkhoffs
- Center for Clinical Transfusion Research, Sanquin Research, Leiden University Medical Center, Leiden, the Netherlands.,Haga Hospital, Den Haag, the Netherlands
| | - Martin R Schipperus
- Haga Hospital, Den Haag, the Netherlands.,TRIP, Transfusion and Transplantation Reactions in Patients, Dutch National Hemovigilance Office, Leiden, the Netherlands
| | - Johanna C Wiersum-Osselton
- TRIP, Transfusion and Transplantation Reactions in Patients, Dutch National Hemovigilance Office, Leiden, the Netherlands
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden University Medical Center, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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14
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Caram-Deelder C, Kreuger AL, Rosendaal FR, van der Bom JG, Middelburg RA. Continuing use of the terms prospective and retrospective and quality of reporting of observational studies: time to update the STROBE guideline? Int J Epidemiol 2016; 45:587-9. [PMID: 26721602 DOI: 10.1093/ije/dyv335] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Camila Caram-Deelder
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Aukje L Kreuger
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Johanna G van der Bom
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Rutger A Middelburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands and Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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