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Spelmink SE, Jager ST, van de Watering L, van der Meer PF, van Gammeren AJ, Wiersum-Osselton JC, Klei TRL, Kerkhoffs JLH. Efficacy and safety of platelet additive solution-E stored platelet concentrates. Transfusion 2023; 63:2273-2280. [PMID: 37909172 DOI: 10.1111/trf.17583] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 09/26/2023] [Accepted: 09/26/2023] [Indexed: 11/02/2023]
Abstract
INTRODUCTION In 2018, platelet (PLT) additive solution-E (PAS-E) was introduced. The implementation of PAS-E was expected to diminish the number of allergic reactions in recipients following a PLT transfusion. Here, we evaluated the efficacy and safety of transfusions with PLTs stored in PAS-E. STUDY DESIGN AND METHODS After implementation of PAS-E, data were collected from 2 cohorts of patients with hematological disorders as well as oncology patients, receiving PLTs in PAS-E. A similar patient group in a recent RCT, receiving PLTs in plasma, was used as a historical control group for both cohorts. Endpoints were corrected count increments (CCIs), bleeding scores (only reported in cohort 1), and the incidence of adverse reactions. RESULTS In cohort 1, the mean 1-h CCI was 14.3 ± 6.9, and the 24-h CCI was 8.7 ± 5.6. In cohort 2, the 1-h CCI was 11.6 ± 7.8 and the 24-h CCI was 7.0 ± 6.1. In the control group, the 1-h CCI was 15.4 ± 5.5 and 24-h CCI 8.7 ± 4.8. Bleeding complications of WHO grade ≥2 occurred in 40% of patients in cohort 1 compared to 44% in plasma PCs. The incidence of adverse reactions was 1.2% in the two PAS-E cohorts, compared to 3.0% in plasma PCs. National hemovigilance data showed a significant reduction in allergic reactions with PAS-E PC transfusions as compared to plasma PCs with an odds ratio of 0.46 (CI 95% 0.37-0.58). CONCLUSION The CCIs of PLTs in PAS-E were decreased compared to plasma PCs, but clinically acceptable. Allergic transfusion reactions were decreased in PAS-E PCs compared to plasma PCs.
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Affiliation(s)
- Saskia E Spelmink
- Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, The Netherlands
| | - Suzanne T Jager
- Department of Hematology, Haga Teaching Hospital, The Hague, The Netherlands
| | - Leo van de Watering
- Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, The Netherlands
| | - Pieter F van der Meer
- Department of Hematology, Haga Teaching Hospital, The Hague, The Netherlands
- Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, The Netherlands
| | | | - Johanna C Wiersum-Osselton
- TRIP (Transfusion and Transplantation Reactions in Patients) Hemovigilance and Biovigilance Office, Leiden, The Netherlands
| | - Thomas R L Klei
- Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, The Netherlands
| | - Jean-Louis H Kerkhoffs
- Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, The Netherlands
- Department of Hematology, Haga Teaching Hospital, The Hague, The Netherlands
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2
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van Vliet ME, Kerkhoffs JLH, Harteveld CL, Houwink EJF. Hemoglobinopathy screening in primary care in the Netherlands: exploring the problems and needs of patients and general practitioners. Eur J Hum Genet 2022; 31:417-423. [PMID: 35945245 PMCID: PMC10133269 DOI: 10.1038/s41431-022-01156-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 05/10/2022] [Accepted: 07/11/2022] [Indexed: 11/09/2022] Open
Abstract
The prevalence of hemoglobinopathies in The Netherlands is increasing due to migration. Hemoglobinopathies are severe hereditary diseases. An informed reproductive choice by at-risk couples, such as pre-implantation diagnosis or termination of affected pregnancies, can be made if carriers are detected prior to conception. Using a qualitative design, the needs and wishes of patients, carriers and general practitioners were evaluated regarding carrier detection of hemoglobinopathies in primary care practice. 30 semi-structured interviews were established with 10 general practitioners, 10 patients and 10 carriers. The interviews were audio-recorded, transcribed verbatim and analysed using content analysis to identify recurring themes. Three themes were generated regarding carrier detection of hemoglobinopathies: (1) a need for more information about hemoglobinopathy, (2) a need for indications when to refer for analysis (carrier diagnostics) and (3) insight concerning organization and roles in care for hemoglobinopathy carriers and patients. These themes reflected a need to increase awareness of hemoglobinopathy, improve competences among general practitioners through better education and improvement of communication with patients and their unidentified family members. This study shows the scope of the problem and the critical need for action to improve informed reproductive decision making for the at-risk population.
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Affiliation(s)
- Margo E van Vliet
- Medical faculty, Leiden University Medical Center, postal zone V0-P, PO Box 9600, 2300RC, Leiden, The Netherlands.
| | - Jean-Louis H Kerkhoffs
- Department of Hematology, HAGA Hospital, Els Borst Eilersplein 275, 2545AA, The Hague, The Netherlands
| | - Cornelis L Harteveld
- Laboratory for Diagnostic Genome Analysis, Department of Clinical Genetics, Leiden University Medical Center, postal zone S6-P, PO Box 9600, 2300RC, Leiden, The Netherlands
| | - Elisa J F Houwink
- Department of Public Health and Primary Care, Leiden University Medical Center, postal zone V0-P, PO Box 9600, 2300RC, Leiden, The Netherlands
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3
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Klanderman RB, Bulle EB, Heijnen JWM, Allen J, Purmer IM, Kerkhoffs JLH, Wiersum-Osselton JC, Vlaar APJ. Reported transfusion-related acute lung injury associated with solvent/detergent plasma - A case series. Transfusion 2022; 62:594-599. [PMID: 35174882 PMCID: PMC9306621 DOI: 10.1111/trf.16822] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 12/03/2021] [Revised: 01/06/2022] [Accepted: 01/06/2022] [Indexed: 11/30/2022]
Abstract
Background Antibody‐mediated transfusion‐related acute lung injury (TRALI) is caused by donor HLA or HNA antibodies in plasma‐containing products. In the Netherlands 55,000 units of solvent/detergent plasma (SDP), a pooled plasma product, are transfused yearly. It's produced by combining plasma from hundreds of donors, diluting harmful antibodies. Due to a lack of reported cases following implementation, some have labeled SDP as “TRALI safe”. Study design and methods Pulmonary transfusion reactions involving SDP reported to the Dutch national hemovigilance network in 2016–2019 were reviewed. Reporting hospitals were contacted for additional information, cases with TRALI and imputability definite, probable, or possible were included and informed consent was sought. Results A total of three TRALI and nine TACO cases were reported involving SDP. The imputability of one TRALI case was revised from possible to unlikely and excluded; in one case no informed consent was obtained. We present a case description of TRALI following SDP transfusion in a 69‐year‐old male, 3 days following endovascular aortic aneurysm repair. The patient received one unit of SDP to correct a heparin‐induced coagulopathy, prior to removal of a spinal catheter post‐operatively. Within five hours he developed hypoxemic respiratory failure requiring intubation, hypotension, bilateral chest infiltrates, and leucopenia. The patient made a full recovery. Conclusion This case of TRALI, following transfusion of a single unit of SDP to a patient without ARDS risk factors, demonstrates that TRALI can occur with this product. Clinicians should remain vigilant and continue to report suspected cases, to help further understanding of SDP‐associated TRALI.
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Affiliation(s)
- Robert B Klanderman
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Esther B Bulle
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Judith Allen
- Department of Quality and Security, HagaZiekenhuis, The Hague, The Netherlands
| | - Ilse M Purmer
- Department of Intensive Care, HagaZiekenhuis, The Hague, The Netherlands
| | | | | | - Alexander P J Vlaar
- Department of Intensive Care, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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4
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Kerkhoffs JLH, So-Osman C. Anneke Brand (1946-2021). Vox Sang 2021; 117:149-150. [PMID: 34918352 DOI: 10.1111/vox.13231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Jean-Louis H Kerkhoffs
- Department of Haematology, Haga Teaching Hospital, The Hague, The Netherlands.,Department of Unit Transfusion Medicine, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Cynthia So-Osman
- Department of Unit Transfusion Medicine, Sanquin Blood Supply Foundation, Amsterdam, The Netherlands.,Department of Haematology, Erasmus Medical Center, Rotterdam, The Netherlands
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5
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Rizzuto V, Koopmann TT, Blanco-Álvarez A, Tazón-Vega B, Idrizovic A, Díaz de Heredia C, Del Orbe R, Pampliega MV, Velasco P, Beneitez D, Santen GWE, Waisfisz Q, Elting M, Smiers FJW, de Pagter AJ, Kerkhoffs JLH, Harteveld CL, Mañú-Pereira MDM. Usefulness of NGS for Diagnosis of Dominant Beta-Thalassemia and Unstable Hemoglobinopathies in Five Clinical Cases. Front Physiol 2021; 12:628236. [PMID: 33613322 PMCID: PMC7893112 DOI: 10.3389/fphys.2021.628236] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 11/11/2020] [Accepted: 01/13/2021] [Indexed: 12/30/2022] Open
Abstract
Unstable hemoglobinopathies (UHs) are rare anemia disorders (RADs) characterized by abnormal hemoglobin (Hb) variants with decreased stability. UHs are therefore easily precipitating, causing hemolysis and, in some cases, leading to dominant beta-thalassemia (dBTHAL). The clinical picture of UHs is highly heterogeneous, inheritance pattern is dominant, instead of recessive as in more prevalent major Hb syndromes, and may occur de novo. Most cases of UHs are not detected by conventional testing, therefore diagnosis requires a high index of suspicion of the treating physician. Here, we highlight the importance of next generation sequencing (NGS) methodologies for the diagnosis of patients with dBTHAL and other less severe UH variants. We present five unrelated clinical cases referred with chronic hemolytic anemia, three of them with severe blood transfusion dependent anemia. Targeted NGS analysis was performed in three cases while whole exome sequencing (WES) analysis was performed in two cases. Five different UH variants were identified correlating with patients’ clinical manifestations. Four variants were related to the beta-globin gene (Hb Bristol—Alesha, Hb Debrousse, Hb Zunyi, and the novel Hb Mokum) meanwhile one case was caused by a mutation in the alpha-globin gene leading to Hb Evans. Inclusion of alpha and beta-globin genes in routine NGS approaches for RADs has to be considered to improve diagnosis’ efficiency of RAD due to UHs. Reducing misdiagnoses and underdiagnoses of UH variants, especially of the severe forms leading to dBTHAL would also facilitate the early start of intensive or curative treatments for these patients.
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Affiliation(s)
- Valeria Rizzuto
- Translational Research in Child and Adolescent Cancer - Rare Anemia Disorders Research Laboratory, Vall d'Hebron Research Institute, ERN-EuroBloodNet Member, Barcelona, Spain.,Josep Carreras Leukaemia Research Institute, Badalona, Spain.,Department of Medicine, Universitat de Barcelona, Barcelona, Spain
| | - Tamara T Koopmann
- Department of Clinical Genetics, Leiden University Medical Center, ERN-EuroBloodNet Member, Leiden, Netherlands
| | - Adoración Blanco-Álvarez
- Hematologic Molecular Genetics Unit, Hematology Department, Hospital Universitari Vall d'Hebron, ERN-EuroBloodNet Member, Barcelona, Spain
| | - Barbara Tazón-Vega
- Hematologic Molecular Genetics Unit, Hematology Department, Hospital Universitari Vall d'Hebron, ERN-EuroBloodNet Member, Barcelona, Spain
| | - Amira Idrizovic
- Translational Research in Child and Adolescent Cancer - Rare Anemia Disorders Research Laboratory, Vall d'Hebron Research Institute, ERN-EuroBloodNet Member, Barcelona, Spain
| | - Cristina Díaz de Heredia
- Oncohematologic Pediatrics Department, Hospital Universitari Vall d'Hebron, ERN-EuroBloodNet Member, Barcelona, Spain
| | - Rafael Del Orbe
- Hematology Department, Hospital Universitario Cruces, Barakaldo, Spain
| | | | - Pablo Velasco
- Oncohematologic Pediatrics Department, Hospital Universitari Vall d'Hebron, ERN-EuroBloodNet Member, Barcelona, Spain
| | - David Beneitez
- Red Blood Cell Disorders Unit, Hematology Department, Hospital Universitari Vall d'Hebron, ERN-EuroBloodNet Member, Barcelona, Spain
| | - Gijs W E Santen
- Department of Clinical Genetics, Leiden University Medical Center, ERN-EuroBloodNet Member, Leiden, Netherlands
| | - Quinten Waisfisz
- Department of Clinical Genetics, VU Medical Center, Amsterdam, Netherlands
| | - Mariet Elting
- Department of Clinical Genetics, VU Medical Center, Amsterdam, Netherlands
| | - Frans J W Smiers
- Department of Pediatric Hematology, Leiden University Medical Center, Leiden, Netherlands
| | - Anne J de Pagter
- Department of Pediatric Hematology, Leiden University Medical Center, Leiden, Netherlands
| | | | - Cornelis L Harteveld
- Department of Clinical Genetics, Leiden University Medical Center, ERN-EuroBloodNet Member, Leiden, Netherlands
| | - Maria Del Mar Mañú-Pereira
- Translational Research in Child and Adolescent Cancer - Rare Anemia Disorders Research Laboratory, Vall d'Hebron Research Institute, ERN-EuroBloodNet Member, Barcelona, Spain
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6
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Kuiken T, Breitbart M, Beer M, Grund C, Höper D, van den Hoogen B, Kerkhoffs JLH, Kroes ACM, Rosario K, van Run P, Schwarz M, Svraka S, Teifke J, Koopmans M. Zoonotic Infection With Pigeon Paramyxovirus Type 1 Linked to Fatal Pneumonia. J Infect Dis 2019; 218:1037-1044. [PMID: 29373675 PMCID: PMC7107406 DOI: 10.1093/infdis/jiy036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 09/26/2017] [Accepted: 01/17/2018] [Indexed: 02/06/2023] Open
Abstract
The characteristics and risk factors of pigeon paramyxovirus type 1 (PPMV-1) infection in humans are poorly known. We performed virological, pathological, and epidemiological analyses of a Dutch case, and compared the results with those of a US case. Both infections occurred in transplant patients under immunosuppressive therapy and caused fatal respiratory failure. Both virus isolates clustered with PPMV-1, which has pigeons and doves as reservoir. Experimentally inoculated pigeons became infected and transmitted the virus to naive pigeons. Both patients were likely infected by contact with infected pigeons or doves. Given the large populations of feral pigeons with PPMV-1 infection in cities, increasing urbanization, and a higher proportion of immunocompromised individuals, the risk of severe human PPMV-1 infections may increase. We recommend testing for avian paramyxovirus type 1, including PPMV-1, in respiratory disease cases where common respiratory pathogens cannot be identified.
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Affiliation(s)
- Thijs Kuiken
- Department of Viroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Mya Breitbart
- College of Marine Science, University of South Florida, Saint Petersburg
| | - Martin Beer
- Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Christian Grund
- Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Dirk Höper
- Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | | | - Jean-Louis H Kerkhoffs
- Department of Medical Microbiology, Leiden University Medical Centre, Bilthoven, The Netherlands
| | - Aloys C M Kroes
- Department of Medical Microbiology, Leiden University Medical Centre, Bilthoven, The Netherlands
| | - Karyna Rosario
- College of Marine Science, University of South Florida, Saint Petersburg
| | - Peter van Run
- Department of Viroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | | | - Sanela Svraka
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Jens Teifke
- Friedrich-Loeffler-Institut, Greifswald-Insel Riems, Germany
| | - Marion Koopmans
- Department of Viroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, The Netherlands
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7
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Meinderts SM, Gerritsma JJ, Sins JWR, de Boer M, van Leeuwen K, Biemond BJ, Rijneveld AW, Kerkhoffs JLH, Habibi A, van Bruggen R, Kuijpers TW, van der Schoot E, Pirenne F, Fijnvandraat K, Tanck MW, van den Berg TK. Identification of genetic biomarkers for alloimmunization in sickle cell disease. Br J Haematol 2019; 186:887-899. [PMID: 31168801 DOI: 10.1111/bjh.15998] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: 01/08/2019] [Revised: 03/18/2019] [Accepted: 03/19/2019] [Indexed: 12/11/2022]
Abstract
Most sickle cell disease (SCD) patients rely on blood transfusion as their main treatment strategy. However, frequent blood transfusion poses the risk of alloimmunization. On average, 30% of SCD patients will alloimmunize while other patient groups form antibodies less frequently. Identification of genetic markers may help to predict which patients are at risk to form alloantibodies. The aim of this study was to evaluate whether genetic variations in the Toll-like receptor pathway or in genes previously associated with antibody-mediated conditions are associated with red blood cell (RBC) alloimmunization in a cohort of SCD patients. In this case-control study, cases had a documented history of alloimmunization while controls had received ≥20 RBC units without alloantibody formation. We used a customized single nucleotide polymorphism (SNP) panel to genotype 690 SNPs in 275 (130 controls, 145 cases) patients. Frequencies were compared using multiple logistic regression analysis. In our primary analysis, no SNPs were found to be significantly associated with alloimmunization after correction for multiple testing. However, in a secondary analysis with a less stringent threshold for significance we found 19 moderately associated SNPs. Among others, SNPs in TLR1/TANK and MALT1 were associated with a higher alloimmunization risk, while SNPs in STAM/IFNAR1 and STAT4 conferred a lower alloimmunization risk.
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Affiliation(s)
- Sanne M Meinderts
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Jorn J Gerritsma
- Department of Paediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.,Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, Univsersity of Amsterdam, Amsterdam, the Netherlands
| | - Joep W R Sins
- Department of Paediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.,Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, Univsersity of Amsterdam, Amsterdam, the Netherlands
| | - Martin de Boer
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Karin van Leeuwen
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Bart J Biemond
- Department of Haematology, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Anita W Rijneveld
- Department of Haematology, Erasmus MC, University Medical Centre, Rotterdam, the Netherlands
| | | | - Anoosha Habibi
- Reference Centre for Sickle Cell Disease, Hôpital Henri Mondor, Créteil, France
| | - Robin van Bruggen
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Taco W Kuijpers
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.,Department of Paediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Ellen van der Schoot
- Department of Experimental Immunohaematology, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - France Pirenne
- Etablissement Français Du Sang Ile de France, INSERM U955, University of Paris Est-Créteil, Hôpital Henri Mondor, Créteil, France
| | - Karin Fijnvandraat
- Department of Paediatric Haematology, Immunology and Infectious Diseases, Emma Children's Hospital, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.,Department of Plasma Proteins, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, Univsersity of Amsterdam, Amsterdam, the Netherlands
| | - Michael W Tanck
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands
| | - Timo K van den Berg
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, Academic Medical Centre, University of Amsterdam, Amsterdam, the Netherlands.,Department of Molecular Cell Biology, VU Medical Centre, Amsterdam, the Netherlands
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8
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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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9
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Middelburg RA, Kerkhoffs JLH, van der Bom JG. Thrombocytopenia and bleeding in myelosuppressed transfusion-dependent patients: a simulation study exploring underlying mechanisms. Clin Epidemiol 2018; 10:401-411. [PMID: 29692632 PMCID: PMC5903482 DOI: 10.2147/clep.s149926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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 Hematology–oncology patients often become severely thrombocytopenic and receive prophylactic platelet transfusions when their platelet count drops below 10×109 platelets/L. This so-called “platelet count trigger” of 10×109 platelets/L is recommended because currently available evidence suggests this is the critical concentration at which bleeding risk starts to increase. Yet, exposure time and lag time may have biased the results of studies on the association between platelet counts and bleeding risks. Methods We performed simulation studies to examine possible effects of exposure time and lag time on the findings of both randomized trials and observational data. Results Exposure time and lag time reduced or even reversed the association between the risk of clinically relevant bleeding and platelet counts. The frequency of platelet count measurements influenced the observed bleeding risk at a given platelet count trigger. A transfusion trigger of 10×109 platelets/L resulted in a severely distorted association, which closely resembled the association reported in the literature. At triggers of 0, 5, 10, and 20×109 platelets/L the observed percentages of patients experiencing bleeding were 18, 19, 19, and 18%. A trigger of 30×109 platelets/L showed an observed bleeding risk of 16% and triggers of 40 and 50×109 platelets/L both resulted in observed bleeding risks of 13%. Conclusion The results from our simulation study show how minimal exposure times and lag times may have influenced the results from previous studies on platelet counts, transfusion strategies, and bleeding risk and caution against the generally recommended universal trigger of 10×109 platelets/L.
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Affiliation(s)
- 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.,Department of Hematology, Hagaziekenhuis, 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
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10
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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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11
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Sins JWR, Fijnvandraat K, Rijneveld AW, Boom MB, Kerkhoffs JLH, van Meurs AH, de Groot MR, Heijboer H, Dresse MF, Lê PQ, Hermans P, Vanderfaeillie A, Van Den Neste EW, Benghiat FS, Kesse-Adu R, Delannoy A, Efira A, Azerad MA, de Borgie CA, Biemond BJ. Effect of N-acetylcysteine on pain in daily life in patients with sickle cell disease: a randomised clinical trial. Br J Haematol 2017. [PMID: 28643376 DOI: 10.1111/bjh.14809] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Joep W R Sins
- Department of Paediatric Haematology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands.,Department of Haematology, Academic Medical Centre, Amsterdam, the Netherlands
| | - Karin Fijnvandraat
- Department of Paediatric Haematology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands
| | - Anita W Rijneveld
- Department of Haematology, Erasmus MC, Erasmus University Medical Centre, Rotterdam, the Netherlands
| | - Martine B Boom
- Department of Paediatric Haematology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands.,Department of Haematology, Academic Medical Centre, Amsterdam, the Netherlands
| | | | | | - Marco R de Groot
- Department of Haematology, University Medical Centre Groningen, Groningen, the Netherlands
| | - Harriët Heijboer
- Department of Paediatric Haematology, Emma Children's Hospital, Academic Medical Centre, Amsterdam, the Netherlands
| | - Marie-Françoise Dresse
- Department of Paediatric Haemato-oncology, Centre Hospitalier Régional de la Citadelle, Liège, Belgium
| | - Phu Quoc Lê
- Department of Haemato-oncology, Hôpital Universitaire des Enfants Reine Fabiola (HUDERF), Brussels, Belgium
| | - Philippe Hermans
- Department of Haemato-oncology, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Anna Vanderfaeillie
- Department of Paediatrics, Centre Hospitalier Universitaire Saint-Pierre, Brussels, Belgium
| | - Eric W Van Den Neste
- Department of Haematology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Fleur S Benghiat
- Department of Haemato-oncolocy, Hôpital Erasme, Brussels, Belgium
| | - Rachel Kesse-Adu
- Department of Haematology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - André Delannoy
- Department of Haematology, Hôpital de Jolimont, Haine-St-Paul, Belgium
| | - André Efira
- Department of Haemato-oncology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium
| | - Marie-Agnès Azerad
- Department of Haemato-oncology, Centre Hospitalier Universitaire Brugmann, Brussels, Belgium.,Department of Haematology, Centre Hospitalier Universitaire de Liège, Liège, Belgium
| | | | - Bart J Biemond
- Department of Haematology, Academic Medical Centre, Amsterdam, the Netherlands
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12
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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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13
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Sins JW, Biemond BJ, van den Bersselaar SM, Heijboer H, Rijneveld AW, Cnossen MH, Kerkhoffs JLH, van Meurs AH, von Ronnen F, Zalpuri S, de Rijke YB, Ellen van der Schoot C, de Haas M, van der Bom JG, Fijnvandraat K. Early occurrence of red blood cell alloimmunization in patients with sickle cell disease. Am J Hematol 2016; 91:763-9. [PMID: 27102719 DOI: 10.1002/ajh.24397] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 04/18/2016] [Accepted: 04/19/2016] [Indexed: 12/14/2022]
Abstract
Red blood cell (RBC) alloimmunization is a major complication of transfusion therapy in sickle cell disease (SCD). Identification of high-risk patients is hampered by lack of studies that take the cumulative transfusion exposure into account. In this retrospective cohort study among previously non-transfused SCD patients in the Netherlands, we aimed to elucidate the association between the cumulative transfusion exposure, first alloimmunization and independent risk factors. A total of 245 patients received 11 952 RBC units. Alloimmunization occurred in 43 patients (18%), half of them formed their first alloantibody before the 8th unit. In patients with exposure to non-extended matched transfusions (ABO and RhD) the cumulative alloimmunization risk increased up to 35% after 60 transfused units. This was significantly higher compared to a general transfused population (HR 6.6, CI 4.2-10.6). Receiving the first transfusion after the age of 5 was an independent risk factor for alloimmunization (HR 2.3, CI 1.0-5.1). Incidental, episodic transfusions in comparison to chronic scheme transfusions (HR 2.3, CI 0.9-6.0), and exposure to non-extended matched units in comparison to extended matching (HR 2.0, CI 0.9-4.6) seemed to confer a higher alloimmunization risk. The majority of first alloantibodies are formed after minor transfusion exposure, substantiating suggestions of a responder phenotype in SCD and stressing the need for risk factor identification. In this study, older age at first transfusion, episodic transfusions and non-extended matched transfusions appeared to be risk factors for alloimmunization. Am. J. Hematol. 91:763-769, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Joep W.R. Sins
- Department of Pediatric Hematology; Emma Children's Hospital, Academic Medical Center; Amsterdam The Netherlands
- Department of Hematology; Academic Medical Center; Amsterdam The Netherlands
| | - Bart J. Biemond
- Department of Hematology; Academic Medical Center; Amsterdam The Netherlands
| | - Sil M. van den Bersselaar
- Department of Pediatric Hematology; Emma Children's Hospital, Academic Medical Center; Amsterdam The Netherlands
- Department of Hematology; Academic Medical Center; Amsterdam The Netherlands
| | - H. Heijboer
- Department of Pediatric Hematology; Emma Children's Hospital, Academic Medical Center; Amsterdam The Netherlands
| | - Anita W. Rijneveld
- Department of Hematology; Erasmus MC, University Medical Center; Rotterdam The Netherlands
| | - Marjon H. Cnossen
- Department of Pediatric Hematology; Erasmus MC, University Medical Center-Sophia Children's Hospital; Rotterdam The Netherlands
| | | | | | - F.B. von Ronnen
- Department of Pediatric Hematology; Emma Children's Hospital, Academic Medical Center; Amsterdam The Netherlands
- Department of Hematology; Academic Medical Center; Amsterdam The Netherlands
| | - Saurabh Zalpuri
- Center for Clinical Transfusion; Sanquin Blood Supply Foundation; Leiden and Department of Clinical Epidemiology; Leiden University Medical Center; Leiden The Netherlands
| | - Yolanda B. de Rijke
- Department of Clinical Chemistry; Erasmus MC, University Medical Center Rotterdam; The Netherlands
| | - C. Ellen van der Schoot
- Department of Experimental Immunohematology; Sanquin Blood Supply Foundation; Amsterdam The Netherlands
| | - Masja de Haas
- Department of Experimental Immunohematology; Sanquin Blood Supply Foundation; Amsterdam The Netherlands
| | - Johanna G. van der Bom
- Center for Clinical Transfusion; Sanquin Blood Supply Foundation; Leiden and Department of Clinical Epidemiology; Leiden University Medical Center; Leiden The Netherlands
| | - Karin Fijnvandraat
- Department of Pediatric Hematology; Emma Children's Hospital, Academic Medical Center; Amsterdam The Netherlands
- Unit of Clinical Transfusion Medicine; Sanquin Blood Supply Foundation; Amsterdam The Netherlands
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14
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Ypma PF, van der Meer PF, Heddle NM, van Hilten JA, Stijnen T, Middelburg RA, Hervig T, van der Bom JG, Brand A, Kerkhoffs JLH. A study protocol for a randomised controlled trial evaluating clinical effects of platelet transfusion products: the Pathogen Reduction Evaluation and Predictive Analytical Rating Score (PREPAReS) trial. BMJ Open 2016; 6:e010156. [PMID: 26817642 PMCID: PMC4735127 DOI: 10.1136/bmjopen-2015-010156] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 12/23/2015] [Accepted: 01/05/2016] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Patients with chemotherapy-induced thrombocytopaenia frequently experience minor and sometimes severe bleeding complications. Unrestrictive availability of safe and effective blood products is presumed by treating physicians as well as patients. Pathogen reduction technology potentially offers the opportunity to enhance safety by reducing bacterial and viral contamination of platelet products along with a potential reduction of alloimmunisation in patients receiving multiple platelet transfusions. METHODS AND ANALYSIS To test efficacy, a randomised, single-blinded, multicentre controlled trial was designed to evaluate clinical non-inferiority of pathogen-reduced platelet concentrates treated by the Mirasol system, compared with standard plasma-stored platelet concentrates using the percentage of patients with WHO grade ≥ 2 bleeding complications as the primary endpoint. The upper limit of the 95% CI of the non-inferiority margin was chosen to be a ≤ 12.5% increase in this percentage. Bleeding symptoms are actively monitored on a daily basis. The adjudication of the bleeding grade is performed by 3 adjudicators, blinded to the platelet product randomisation as well as by an automated computer algorithm. Interim analyses evaluating bleeding complications as well as serious adverse events are performed after each batch of 60 patients. The study started in 2010 and patients will be enrolled up to a maximum of 618 patients, depending on the results of consecutive interim analyses. A flexible stopping rule was designed allowing stopping for non-inferiority or futility. Besides analysing effects of pathogen reduction on clinical efficacy, the Pathogen Reduction Evaluation and Predictive Analytical Rating Score (PREPAReS) is designed to answer several other pending questions and translational issues related to bleeding and alloimmunisation, formulated as secondary and tertiary endpoints. ETHICS AND DISSEMINATION Ethics approval was obtained in all 3 participating countries. Results of the main trial and each of the secondary endpoints will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NTR2106; Pre-results.
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Affiliation(s)
- Paula F Ypma
- Department of Hematology, HAGA Teaching Hospital Den Haag, The Netherlands
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
| | | | - Nancy M Heddle
- Faculty of Health Sciences, Department of Medicine, Canadian Blood Services, McMaster University, and Centre for Innovation, Hamilton, Ontario, Canada
| | - Joost A van Hilten
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
| | - Theo Stijnen
- Leiden University Medical Centre, 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
| | - Tor Hervig
- Department of Immunology and Transfusion Medicine, and Department of Clinical Science, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - 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
| | - Anneke Brand
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
| | - Jean-Louis H Kerkhoffs
- Department of Hematology, HAGA Teaching Hospital Den Haag, The Netherlands
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
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15
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Kusters E, Kerkhoffs JLH, van Rossum AP. [Thalassaemia diagnostics]. Ned Tijdschr Geneeskd 2014; 158:A7988. [PMID: 25387979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The thalassaemias are characterised by quantitative aberrations in the production of the globin chains that make up haemoglobin, and are a subgroup of the haemoglobinopathies. In this LabQuiz we show how thalassaemia carrier status can be indicated in the results of regular laboratory tests, and discuss the laboratory diagnostics that can confirm or rule out thalassaemia. In these two cases we will present a man of Moroccan descent, and two brothers of Filipino descent, all with anaemia and microcytosis. We show it is possible to differentiate between iron-deficiency anaemia and thalassaemia carrier status on the basis of a complete blood count and measurement of ferritin levels, and which laboratory diagnostics can be subsequently performed in order to confirm a suspicion of thalassaemia. The background section discusses the properties and pitfalls of routine laboratory diagnostics for the thalassaemias, and thalassaemia diagnostics in the Dutch newborn screening programme.
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Affiliation(s)
- Elske Kusters
- Leids Universitair Medisch Centrum, afd. Klinische Chemie en Laboratoriumgeneeskunde, Leiden
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16
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Kerkhoffs JLH, Van Putten WLJ, Novotny VMJ, Te Boekhorst PA, Schipperus MR, Zwaginga JJ, Van Pampus LCM, De Greef GE, Luten M, Huijgens PC, Brand A, Van Rhenen DJ. Clinical effectiveness of leucoreduced, pooled donor platelet concentrates, stored in plasma or additive solution with and without pathogen reduction. Br J Haematol 2010; 150:209-17. [DOI: 10.1111/j.1365-2141.2010.08227.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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17
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Kerkhoffs JLH, Eikenboom JC, van de Watering LM, van Wordragen-Vlaswinkel RJ, Wijermans PW, Brand A. The clinical impact of platelet refractoriness: correlation with bleeding and survival. Transfusion 2008; 48:1959-65. [DOI: 10.1111/j.1537-2995.2008.01799.x] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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18
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Kerkhoffs JLH, Eikenboom JC, Schipperus MS, van Wordragen-Vlaswinkel RJ, Brand R, Harvey MS, de Vries RR, Barge R, van Rhenen DJ, Brand A. A multicenter randomized study of the efficacy of transfusions with platelets stored in platelet additive solution II versus plasma. Blood 2006; 108:3210-5. [PMID: 16825492 DOI: 10.1182/blood-2006-04-020131] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Randomized studies testing the clinical efficacy of platelet additive solutions (PASs) for storage of platelets are scarce and often biased by patient selection. We conducted a multicenter, randomized study to investigate clinical efficacy of platelets stored in PAS II versus plasma, also including patients with clinical complications associated with increased platelet consumption. A total of 168 evaluable patients received pooled buffy coat–derived platelet concentrates (PCs) suspended in either plasma (n = 354) or PAS II (n = 411) stored up to 5 days. Both univariate as well as multivariate analysis showed a significant effect of used storage medium in regard to 1- and 24-hour count increments and corrected count increments, in favor of plasma PCs. However, there were no significant differences between the groups regarding bleeding complications and transfusion interval. Adverse transfusion reactions occurred significantly less after transfusions with PAS II PCs (P = .04). Multivariate analysis showed no significant effect of the used storage medium on the incidence of 1- and 24-hour transfusion failure. We showed safety and efficacy of PAS II PCs in intensively treated patients; however, plasma PCs show superior increments.
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