1
|
Faddy HM, Osiowy C, Custer B, Busch M, Stramer SL, Adesina O, van de Laar T, Tsoi WC, Styles C, Kiely P, Margaritis A, Kwon SY, Qiu Y, Deng X, Lewin A, Jørgensen SW, Erikstrup C, Juhl D, Sauleda S, Camacho Rodriguez BA, Coral LJCS, Gaviria García PA, Oota S, O'Brien SF, Wendel S, Castro E, Navarro Pérez L, Harvala H, Davison K, Reynolds C, Jarvis L, Grabarczyk P, Kopacz A, Łętowska M, O'Flaherty N, Young F, Williams P, Burke L, Chua SS, Muylaert A, Page I, Jones A, Niederhauser C, Vermeulen M, Laperche S, Gallian P, Sawadogo S, Satake M, Gharehbaghian A, Addas-Carvalho M, Blanco S, Gallego SV, Seltsam A, Weber-Schehl M, Al-Riyami AZ, Al Maamari K, Alawi FB, Pandey HC, Mbanya D, França RA, Charlewood R. International review of blood donation nucleic acid amplification testing. Vox Sang 2024; 119:315-325. [PMID: 38390819 DOI: 10.1111/vox.13592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 01/01/2024] [Accepted: 01/02/2024] [Indexed: 02/24/2024]
Abstract
BACKGROUND AND OBJECTIVES Nucleic acid amplification testing (NAT), in blood services context, is used for the detection of viral and parasite nucleic acids to reduce transfusion-transmitted infections. This project reviewed NAT for screening blood donations globally. MATERIALS AND METHODS A survey on NAT usage, developed by the International Society of Blood Transfusion Working Party on Transfusion-transmitted Infectious Diseases (ISBT WP-TTID), was distributed through ISBT WP-TTID members. Data were analysed using descriptive statistics. RESULTS Forty-three responses were received from 32 countries. Increased adoption of blood donation viral screening by NAT was observed over the past decade. NAT-positive donations were detected for all viruses tested in 2019 (proportion of donations positive by NAT were 0.0099% for human immunodeficiency virus [HIV], 0.0063% for hepatitis C virus [HCV], 0.0247% for hepatitis B virus [HBV], 0.0323% for hepatitis E virus [HEV], 0.0014% for West Nile virus [WNV] and 0.00005% for Zika virus [ZIKV]). Globally, over 3100 NAT-positive donations were identified as NAT yield or solely by NAT in 2019 and over 22,000 since the introduction of NAT, with HBV accounting for over half. NAT-positivity rate was higher in first-time donors for all viruses tested except WNV. During 2019, a small number of participants performed NAT for parasites (Trypanosoma cruzi, Babesia spp., Plasmodium spp.). CONCLUSION This survey captures current use of blood donation NAT globally. There has been increased NAT usage over the last decade. It is clear that NAT contributes to improving blood transfusion safety globally; however, there is a need to overcome economic barriers for regions/countries not performing NAT.
Collapse
Affiliation(s)
- Helen M Faddy
- School of Health, University of the Sunshine Coast, Petrie, Queensland, Australia
- Research and Development, Australian Red Cross Lifeblood, Brisbane, Queensland, Australia
| | - Carla Osiowy
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Michael Busch
- Vitalant Research Institute, San Francisco, California, USA
| | - Susan L Stramer
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland, USA
| | | | - Thijs van de Laar
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, the Netherlands
| | - Wai-Chiu Tsoi
- Hong Kong Red Cross Blood Transfusion Service, Kowloon, Hong Kong
| | - Claire Styles
- Pathology & Clinical Governance, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Phil Kiely
- Pathology & Clinical Governance, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - Angelo Margaritis
- Manufacturing & Logistics, Australian Red Cross Lifeblood, Melbourne, Victoria, Australia
| | - So-Yong Kwon
- Korean Red Cross Blood Services, Wonju, Republic of Korea
| | - Yan Qiu
- Beijing Red Cross Blood Centre, Beijing, China
| | | | - Antoine Lewin
- Medical Affairs and Innovation, Héma-Québec, Saint-Laurent, Quebec, Canada
| | | | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - David Juhl
- University Hospital of Schleswig-Holstein, Institute of Transfusion Medicine, Kiel, Germany
| | | | | | | | | | - Sineenart Oota
- National Blood Centre, Thai Red Cross Society, Bangkok, Thailand
| | | | | | - Emma Castro
- Centro de Transfusión de la Comunidad Valenciana, Valencia, Spain
| | | | - Heli Harvala
- Microbiology Services, NHS Blood and Transplant, Bristol, UK
| | - Katy Davison
- NHSBT/UKHSA Epidemiology Unit, UKHSA, London, UK
| | | | - Lisa Jarvis
- Scottish National Blood Transfusion Service, Edinburgh, Scotland, UK
| | - Piotr Grabarczyk
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Aneta Kopacz
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | | | - Fiona Young
- Irish Blood Transfusion Service, Dublin, Ireland
| | | | - Lisa Burke
- Irish Blood Transfusion Service, Dublin, Ireland
| | | | | | - Isabel Page
- Centro de Hemoterapia y Hemodonacion de Castilla y Leon, Valladolid, Spain
| | - Ann Jones
- Welsh Blood Service, Pontyclun, Wales, UK
| | | | - Marion Vermeulen
- The South African National Blood Service, Weltevreden Park, South Africa
| | - Syria Laperche
- Etablissement Français du Sang, La Plaine Saint Denis, Tours, France
| | - Pierre Gallian
- Etablissement Français du Sang, La Plaine Saint Denis, Tours, France
| | - Salam Sawadogo
- National Blood Transfusion Center of Burkina Faso, Ouagadougou, Burkina Faso
| | | | - Ahmad Gharehbaghian
- Laboratory Hematology & Blood Bank Department, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | | | - Sandra V Gallego
- Fundación Banco Central de Sangre, Córdoba, Argentina
- Virology Institute, School of Medicine, National University of Cordoba, Córdoba, Argentina
| | - Axel Seltsam
- Bavarian Red Cross Blood Donation Service, Wiesentheid, Germany
| | | | - Arwa Z Al-Riyami
- Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Khuloud Al Maamari
- Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Fatma Ba Alawi
- Sultan Qaboos University Hospital, Sultan Qaboos University, Muscat, Oman
| | - Hem Chandra Pandey
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Dora Mbanya
- National Blood Transfusion Service, Yaoundé, Cameroon
| | | | | |
Collapse
|
2
|
Faddy HM, Osiowy C, Custer B, Busch M, Stramer SL, Dean MM, Acutt J, Viennet E, van de Laar T, Tsoi WC, Styles C, Kiely P, Margaritis A, Kwon SY, Qiu Y, Deng X, Lewin A, Jørgensen SW, Erikstrup C, Juhl D, Sauleda S, Camacho Rodriguez BA, Soto Coral LJC, Gaviria García PA, Oota S, O'Brien SF, Wendel S, Castro E, Navarro Pérez L, Harvala H, Davison K, Reynolds C, Jarvis L, Grabarczyk P, Kopacz A, Łętowska M, O'Flaherty N, Young F, Williams P, Burke L, Chua SS, Muylaert A, Page I, Jones A, Niederhauser C, Vermeulen M, Laperche S, Gallian P, Satake M, Addas-Carvalho M, Blanco S, Gallego SV, Seltsam A, Weber-Schehl M, Al-Riyami AZ, Al Maamari K, Alawi FB, Pandey HC, França RA, Charlewood R. An international review of the characteristics of viral nucleic acid-amplification testing (NAT) reveals a trend towards the use of smaller pool sizes and individual donation NAT. Vox Sang 2024. [PMID: 38516962 DOI: 10.1111/vox.13617] [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: 01/10/2024] [Revised: 02/19/2024] [Accepted: 03/03/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND AND OBJECTIVES Nucleic acid-amplification testing (NAT) is used for screening blood donations/donors for blood-borne viruses. We reviewed global viral NAT characteristics and NAT-yield confirmatory testing used by blood operators. MATERIALS AND METHODS NAT characteristics and NAT-yield confirmatory testing used during 2019 was surveyed internationally by the International Society of Blood Transfusion Working Party Transfusion-Transmitted Infectious Diseases. Reported characteristics are presented herein. RESULTS NAT was mainly performed under government mandate. Human immunodeficiency virus (HIV), hepatitis C virus (HCV) and hepatitis B virus (HBV) NAT was performed on all donors and donation types, while selective testing was reported for West Nile virus, hepatitis E virus (HEV), and Zika virus. Individual donation NAT was used for HIV, HCV and HBV by ~50% of responders, while HEV was screened in mini-pools by 83% of responders performing HEV NAT. Confirmatory testing for NAT-yield samples was generally performed by NAT on a sample from the same donation or by NAT and serology on samples from the same donation and a follow-up sample. CONCLUSION In the last decade, there has been a trend towards use of smaller pool sizes or individual donation NAT. We captured characteristics of NAT internationally in 2019 and provide insights into confirmatory testing approaches used for NAT-yields, potentially benefitting blood operators seeking to implement NAT.
Collapse
Affiliation(s)
- Helen M Faddy
- School of Health, University of the Sunshine Coast, Petrie, Queensland, Australia
- Research and Development, Australian Red Cross Lifeblood, Brisbane, Queensland, Australia
| | - Carla Osiowy
- National Microbiology Laboratory, Public Health Agency of Canada, Manitoba, Canada
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California San Francisco, California, USA
| | - Michael Busch
- Vitalant Research Institute, San Francisco, California, USA
| | | | - Melinda M Dean
- School of Health, University of the Sunshine Coast, Petrie, Queensland, Australia
- Research and Development, Australian Red Cross Lifeblood, Brisbane, Queensland, Australia
| | - Jessika Acutt
- School of Health, University of the Sunshine Coast, Petrie, Queensland, Australia
| | - Elvina Viennet
- Research and Development, Australian Red Cross Lifeblood, Brisbane, Queensland, Australia
| | - Thijs van de Laar
- Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Wai-Chiu Tsoi
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - Claire Styles
- Pathology & Clinical Governance, Australian Red Cross Lifeblood, Melbourne, Australia
| | - Phil Kiely
- Pathology & Clinical Governance, Australian Red Cross Lifeblood, Melbourne, Australia
| | - Angelo Margaritis
- Manufacturing & Logistics, Australian Red Cross Lifeblood, Melbourne, Australia
| | - So-Yong Kwon
- Korean Red Cross Blood Services, Republic of Korea
| | - Yan Qiu
- Beijing Red Cross Blood Centre, Beijing, China
| | | | | | | | | | - David Juhl
- University Hospital of Schleswig-Holstein, Institute of Transfusion Medicine, Germany
| | | | | | | | | | | | | | | | - Emma Castro
- Centro de Transfusión de la Comunidad Valenciana, Spain
| | | | - Heli Harvala
- Microbiology Services, NHS Blood and Transplant, UK
| | | | | | - Lisa Jarvis
- Scottish National Blood Transfusion Service, UK
| | - Piotr Grabarczyk
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Aneta Kopacz
- Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | | | - Fiona Young
- Irish Blood Transfusion Service, Dublin, Ireland
| | | | - Lisa Burke
- Irish Blood Transfusion Service, Dublin, Ireland
| | | | | | - Isabel Page
- Centro de Hemoterapia y Hemodonacion de Castilla y Leon, Spain
| | | | - Christoph Niederhauser
- Interregional Blood Transfusion SRC, Switzerland
- Institute for Infectious Diseases, University of Berne, Berne, Switzerland
| | | | - Syria Laperche
- Etablissement Français du Sang, La Plaine Saint Denis, France
| | - Pierre Gallian
- Etablissement Français du Sang, La Plaine Saint Denis, France
| | | | | | | | - Sandra V Gallego
- Fundación Banco Central de Sangre, Argentina
- Virology Institute, School of Medicine, National University of Cordoba, Argentina
| | - Axel Seltsam
- Bavarian Red Cross Blood Donation Service, Wiesentheid, Germany
| | | | - Arwa Z Al-Riyami
- Sultan Qaboos University Hospital, Sultan Qaboos University, Oman
| | | | - Fatma Ba Alawi
- Sultan Qaboos University Hospital, Sultan Qaboos University, Oman
| | - Hem Chandra Pandey
- Department of Transfusion Medicine, All India Institute of Medical Sciences, New Delhi, India
| | | | | |
Collapse
|
3
|
Tsoi WC, Simpson C, Jarvis L, Smith A, Robbins N, Sepetiene R, Bhatnagar S. Multicenter Evaluation of the New Alinity s Anti-HCV II Assay for Routine Hepatitis C Virus Blood Screening. Journal of Clinical Virology Plus 2023. [DOI: 10.1016/j.jcvp.2023.100136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
|
4
|
Ng SC, Wong HK, So CK, Lau CW, Leung JNS, Tsoi WC, Lee CK. Streptococcus bovis bacteraemia should be investigated for early detection of colorectal pathology. Hong Kong Med J 2019; 25:414. [PMID: 31761757 DOI: 10.12809/hkmj198135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- S C Ng
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - H K Wong
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - C K So
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - C W Lau
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - J N S Leung
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - W C Tsoi
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| | - C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong
| |
Collapse
|
5
|
Tsoi WC, Zhu X, To APC, Holmberg J. Hepatitis E virus infection in Hong Kong blood donors. Vox Sang 2019; 115:11-17. [PMID: 31709559 DOI: 10.1111/vox.12846] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/27/2019] [Accepted: 08/28/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND AND OBJECTIVES In Hong Kong, the dominant circulating hepatitis E virus (HEV) genotype is type 4, which can cause more severe clinical consequences than type 3. The aim of this study was to determine the HEV prevalence in Hong Kong blood donors. MATERIALS AND METHODS Unlinked donation samples (n = 10 000) collected in March to May 2015 were tested for HEV RNA using the Procleix HEV assay in an individual donation format (IDT). A subset of 2000 samples were tested for IgG and IgM anti-HEV using the Wantai enzyme-linked immunosorbent assay (ELISA). Nucleic acid testing (NAT) initial reactive results were retested once, and repeatedly reactive donations were subjected to alternative molecular procedures as confirmation tests. RESULTS One in 5000 Hong Kong blood donors was positive for HEV RNA (0·02%). The two RNA positive samples were also IgG and IgM anti-HEV positive. One of the two RNA positive donors could be sequenced revealing genotype type 4. Anti-HEV seroprevalence was estimated as 15·5% among all donors. IgG anti-HEV positive rate for age group 16-20 was 3·1%, and it increased with age to 43·1% for age group 51-60. Sero-positivity was higher in males (male donors 18·1% vs. female donors 13·2%), but it was mostly due to the difference in a specific age group (41-50). CONCLUSION Hepatitis E virus RNA positive rate of 0·02% was within the reported range of HEV RNA frequency in developed countries. One donor was confirmed to be genotype 4, which is the dominant genotype in circulation in Hong Kong.
Collapse
Affiliation(s)
- Wai-Chiu Tsoi
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China
| | - Xiaomei Zhu
- Grifols Diagnostic Solutions Inc, Emeryville, CA, USA
| | - Amanda Pui-Chi To
- Public Health Laboratory Services Branch, Centre for Health Protection, Department of Health, Hong Kong, China
| | | |
Collapse
|
6
|
Seed CR, Allain JP, Lozano M, Laperche S, Gallian P, Gross S, Kwon SY, Oh EY, Kim JN, Chua SS, Lam S, Ang AL, Tsoi WC, Hewitt PE, Davison K, Tettmar K, O'Flaherty N, Boland F, Williams P, Pomeroy L, Wendel S, Fachini R, Scuracchio PSP, Carminato P, Fearon M, O'Brien SF, Delages G, Kiely P, Hoad VC, Matsubayashi K, Satake M, Taira R, Stramer SL, Sauleda S, Bes M, Piron M, Ekiaby ME, Vermeulen M, Stezinar SL, Nograšek P, Jarvis LM, Petrik J, Charlewood R, Flanagan P, Grabarczyk P, Kopacz A, Łętowska M, Schmidt M, Seifried E. International forum on Occult hepatitis B infection and transfusion safety. Vox Sang 2019; 114:397-406. [PMID: 30818422 DOI: 10.1111/vox.12744] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
7
|
Sharma RR, Lozano M, Fearon M, Bigham M, Djoudi R, Gallian P, Woimant G, Lee C, Leung JNS, Tsoi WC, Marwaha N, Sachdev S, Tadokoro K, Tani Y, Matsukura H, Shantseva N, Zhiburt E, Hindawi S, Chay J, Huang T, Teo D, Moleli N, Oyonarte S, Jayasekara SBA, Bokhorst A, van den Burg P, Hewitt P, Bianco C, Kessler D. Vox Sanguinis International Forum on donor notification and counselling strategies for markers of transfusion-transmissible infections. Vox Sang 2017; 112:e1-e21. [PMID: 28318012 DOI: 10.1111/vox.12508] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | | | - M Fearon
- Medical Microbiology, Canadian Blood Services, 67 College Street, Toronto, ON, Canada
| | - M Bigham
- Canadian Blood Services, 4750 Oak Street, Vancouver, BC, V6H 2N9, Canada
| | - R Djoudi
- Etablissement Français du Sang, 20, avenue du stade de France, 93218, La Plaine Saint Denis Paris, France
| | - P Gallian
- Etablissement Français du Sang, Qualification Biologique du Don, 149 Boulevard Baille, Marseille, 13005, France
| | - G Woimant
- Etablissement Français du Sang, Médecine, la Recherche et l'Innovation, La Plaine Saint-Denis Île-de-France, France
| | - C Lee
- Hong Kong Red Cross Blood Transfusion Service, 15, King's Park Rise, Kowloon Hong Kong, China
| | - J N S Leung
- Hong Kong Red Cross Blood Transfusion Service, Blood Collection and Donor Recruitment Department, 15 King's Park Rise, Kowloon, Hong Kong, China
| | - W C Tsoi
- Hong Kong Red Cross Blood Transfusion Service, Laboratory Department, 15 King's Park Rise, Kowloon Hong Kong, China
| | - N Marwaha
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - S Sachdev
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - K Tadokoro
- Japanese Red Cross Blood Service, 1-1-3 Shiba Daimon Minato-ku, Tokyo, 105-8521, Japan
| | - Y Tani
- Japanese Red Cross Osaka Blood Center, 2-4-43 Morinomiya Joto-ku, Osaka, 536-8505, Japan
| | - H Matsukura
- Japanase Red Cross Kinki Block Blood Center, 7-5-17 Saito Asagi, Ibaraki, 567-0085, Japan
| | -
- State Health Care Facility Sverdlovsk Regional Blood Transfusion Station, 8 Palmyro Tolyatti Street, Ekaterinburg, 620000, Russia
| | - N Shantseva
- Laboratory Diagnosis' Department, 7A, Lenin Street, Apt. 50, Pervouralsk, Sverdlovsk Reg, 623111, Russsia
| | - E Zhiburt
- Blood Transfusion Department, Pirogov National Medical Surgical Center, 70, Nizhnyaya Pervomayskaya ul., Moscow, 105203, Russia
| | - S Hindawi
- Blood Transfusion Services, King Abdulaziz University, PO Box 80215, Jeddah, 21589, Saudi Arabia
| | - J Chay
- Blood Services Group, Health Sciences Authority, 11 Outram Road, Singapore, 169078, Singapore
| | - T Huang
- Blood Services Group, Health Sciences Authority, 11 Outram Road, Singapore, 169078, Singapore
| | - D Teo
- Blood Services Group, 11 Outram Road, Singapore, 169078, Singapore
| | - N Moleli
- South African National Blood Service, 1 Constantia Boulevard, Constantia Kloof Ext 22, 1709, Gauteng, South Africa
| | - S Oyonarte
- Blood Transfusion Center, Seville, Spain
| | - S B A Jayasekara
- National Blood Centre, 555/5D, Elvitigala Mawatha, Narahenpita Colombo 05, Sri Lanka
| | - A Bokhorst
- Sanquin Blood Supply, 1066 CX, Amsterdam, The Netherlands
| | - P van den Burg
- Transfusion Medicine, Sanquin Blood Supply, Plesmanlaan 125, 1066 CX, Amsterdam, The Netherlands
| | - P Hewitt
- NHS Blood and Transplant, London, UK
| | - C Bianco
- International Society of Blood Transfusion, 6524 Elgin Lane, Bethesda, MD, 20817, USA
| | - D Kessler
- New York Blood Center, 310 East 67th Street, New York, NY, 10065, USA
| |
Collapse
|
8
|
Liu APY, Cheuk DKL, Lee AHY, Lee PPW, Chiang AKS, Ha SY, Tsoi WC, Chan GCF. Cyclosporin A for persistent or chronic immune thrombocytopenia in children. Ann Hematol 2016; 95:1881-6. [PMID: 27525725 DOI: 10.1007/s00277-016-2791-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [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: 05/31/2016] [Accepted: 08/05/2016] [Indexed: 11/28/2022]
Abstract
Twenty percent of children with immune thrombocytopenia (ITP) develop a chronic course where treatment strategy is less established. Cyclosporin A (CSA) has been shown to be effective in small series of children with chronic ITP and might reduce the need for chronic steroid therapy and/or splenectomy. We reviewed consecutive patients below 18 years old with persistent or chronic ITP treated with CSA in our unit between January 1998 and June 2015. Thirty patients (14 boys and 16 girls) were included. The median age at initial diagnosis of ITP was 5 years (range 0.5-16.2 years). CSA was started at a median of 13.9 months (range 3.4-124 months) after initial diagnosis and given for a median duration of 9.3 months (range 0.2-63.9 months). The median platelet count before commencement was 12 × 10(9)/L (range 4-199 × 10(9)/L). The median dose of CSA was 6 mg/kg/day (range 2.4-7.5 mg/kg/day). Complete response (CR) or response (R) was achieved in 17 patients (57 %), and 7 (23 %) had sustained response. Side effects (most commonly hirsutism) were tolerable and reversible. CSA appeared effective in about half of persistent or chronic ITP patients and safe as a second-line agent in managing these children.
Collapse
Affiliation(s)
- Anthony P Y Liu
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China.
| | - Daniel K L Cheuk
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Ana H Y Lee
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Pamela P W Lee
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - Alan K S Chiang
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - S Y Ha
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| | - W C Tsoi
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong Special Administrative Region, China
| | - Godfrey C F Chan
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong Special Administrative Region, China
| |
Collapse
|
9
|
Tsoi WC, Lelie N, Lin CK. Enhanced detection of hepatitis B virus in Hong Kong blood donors after introduction of a more sensitive transcription-mediated amplification assay. Transfusion 2013; 53:2477-88. [PMID: 23521050 DOI: 10.1111/trf.12165] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Revised: 01/18/2013] [Accepted: 01/27/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND A total of 517,072 and 399,326 consecutive donations were screened for hepatitis B virus (HBV) by individual-donation nucleic acid testing (ID-NAT) using Ultrio and Ultrio Plus assays (Novartis Diagnostics), respectively. The impact of more sensitive HBV detection by the latter assay version was established by comparing NAT yield and transmission risk. STUDY DESIGN AND METHODS Donations were screened simultaneously for HBV serologic markers and ID-NAT, followed by discriminatory assay and confirmatory test algorithms. Window period (WP) reduction and residual HBV transmission risk were computed using mathematical modeling. RESULTS HBV NAT-yield rates for both WP and occult HBV infection (OBI) increased significantly from 1:34,471 to 1:17,362 (p = 0.036) and from 1:5120 to 1:2450 (p < 0.0001), despite a 1.2- and 1.6-fold decrease in hepatitis B surface antigen (HBsAg) incidence and prevalence rates respectively. After adjusting for this bias, the WP and OBI NAT-yield improvement factors were 2.3 and 3.4, respectively, higher than a less than 1.5-fold increase estimated from analytical sensitivity studies on HBV Genotype A and C standards. The current WP transmission risk with Ultrio Plus screening was estimated at 1:55,000 compared to 1:22,000 with HBsAg testing. CONCLUSION The observed greater than twofold enhanced WP NAT yield with the Ultrio Plus assay can be explained by greater than 10-fold increased analytical sensitivity in detecting the HBV Genotype B and C strains in Hong Kong. Direct comparison studies of the two assay versions on dilutions of HBV NAT-yield samples are required to confirm this hypothesis.
Collapse
Affiliation(s)
- Wai-Chiu Tsoi
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong, China; Lelie Research, Paris, France
| | | | | |
Collapse
|
10
|
Abstract
BACKGROUND Predonation hemoglobin (PDH) is used to safeguard donors' welfare, and low hemoglobin (Hb) is known to be the most frequent reason for donor deferral. A study was initiated to assess the PDH and iron status of blood donors in Hong Kong. STUDY DESIGN AND METHODS This observational study was designed with four groups of whole blood donors invited (group 1-eligible first time donors, group 2-eligible repeat donors with zero or one donation in preceding 12 months, group 3-eligible repeat donors with at least two donations in preceding 12 months, group 4-repeat donors being deferred for low PDH). Predonation blood samples were obtained for blood counts and iron status. Mann-Whitney test, Kruskal-Wallis test, and chi-square test for trend were applied for statistical analysis. RESULTS A total of 836 donors were recruited, of which 35 were excluded because of hemoglobinopathy. An inverse relationship between serum ferritin level and number of donations in the preceding 12 months was observed in both sexes. Iron deficiency was significantly seen in 35.1% of male and 65.3% of female deferred donors. More importantly, up to 7.2, 5.8, and 29.5% of the female donors in groups 1, 2, and 3 were found to be iron deficient despite having a high enough PDH. CONCLUSION This is the first study to assess PDH and iron status in Chinese blood donors. Iron depletion is noted with increasing number of blood donations in the preceding 12 months. Advice on iron repletion is a necessary step for donor welfare and strategies should be developed to ensure that donors have adequate PDH.
Collapse
Affiliation(s)
- C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong SAR, China.
| | | | | | | | | | | |
Collapse
|
11
|
Abstract
BACKGROUND Hepatitis C virus (HCV) infection can result in serious hepatic complications and hence potentially significant burden to the society. Despite advances in technology, transfusion-transmitted HCV infection still exists. To further minimise the risk, a review on the epidemiology of HCV infection among Chinese blood donors in Hong Kong was conducted. METHODS All donations associated with HCV infection confirmed by positive serologic diagnosis with or without molecular confirmation during the period from 2003 to 2010 were studied. Demographic data were retrieved and risk factors were identified. RESULTS HCV infection was more commonly seen in first time donors and donors with blood transfusion history before the availability of HCV testing, whereas its association with intravenous drug use was noted to be decreasing. Interestingly, half of the HCV positive donors in 2008-2010 were young donors aged below 21, which was also the group with the highest rate of no known source of infection. CONCLUSION A subgroup of younger age donors was found to have no known risk factor. To develop better screening strategy, it is recommended that a more detailed analysis of this group of donors is required.
Collapse
Affiliation(s)
- H K Wong
- Blood Collection and Donor Recruitment Department, Hong Kong Red Cross Blood Transfusion Service, Kowloon, Hong Kong, China
| | | | | | | | | |
Collapse
|
12
|
Roth WK, Busch MP, Schuller A, Ismay S, Cheng A, Seed CR, Jungbauer C, Minsk PM, Sondag-Thull D, Wendel S, Levi JE, Fearon M, Delage G, Xie Y, Jukic I, Turek P, Ullum H, Tefanova V, Tilk M, Reimal R, Castren J, Naukkarinen M, Assal A, Jork C, Hourfar MK, Michel P, Offergeld R, Pichl L, Schmidt M, Schottstedt V, Seifried E, Wagner F, Weber-Schehl M, Politis C, Lin CK, Tsoi WC, O'Riordan J, Gottreich A, Shinar E, Yahalom V, Velati C, Satake M, Sanad N, Sisene I, Bon AH, Koppelmann M, Flanagan P, Flesland O, Brojer E, Lętowska M, Nascimento F, Zhiburt E, Chua SS, Teo D, Stezinar SL, Vermeulen M, Reddy R, Park Q, Castro E, Eiras A, Gonzales Fraile I, Torres P, Ekermo B, Niederhauser C, Chen H, Oota S, Brant LJ, Eglin R, Jarvis L, Mohabir L, Brodsky J, Foster G, Jennings C, Notari E, Stramer S, Kessler D, Hillyer C, Kamel H, Katz L, Taylor C, Panzer S, Reesink HW. International survey on NAT testing of blood donations: expanding implementation and yield from 1999 to 2009. Vox Sang 2011; 102:82-90. [PMID: 21933190 DOI: 10.1111/j.1423-0410.2011.01506.x] [Citation(s) in RCA: 146] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
|
13
|
Devine DV, Sher GD, Reesink HW, Panzer S, Hetzel PAS, Wong JK, Horvath M, Leitner GC, Schennach H, Nussbaumer W, Genoe K, Cioffi JM, Givisiez FN, Rogerson M, Howe D, Delage G, Sarappa C, Fu Y, Sarlija D, Vuk T, Strauss Patko M, Balija M, Jukić I, Ali A, Auvinen MK, Jaakonsalo E, Cazenave JP, Waller C, Kientz D, David B, Walther-Wenke G, Heiden M, Lin CK, Tsoi WC, Lee CK, Barotine-Toth K, Sawant RB, Murphy W, Quirke B, Bowler P, Shinar E, Yahalom V, Aprili G, Piccoli P, Gandini G, Tadokaro K, Nadarajan VS, de Kort W, Jansen N, Flanagan P, Forsberg PO, Hervig T, Letowska M, Lachert E, Dudziak K, Antoniewicz-Papis J, de Olim G, Nascimento F, Hindawi S, Teo D, Reddy R, Scholtz J, Swanevelder R, Rovira LP, Sauleda S, Carasa MAV, Vaquero MP, Ania MA, Gulliksson H, Holdsworth S, Cotton S, Howell C, Baldwin C, Cusick RM, Geele GA, Paden C, McEvoy P, Gottschall JL, McLaughlin LS, Benjamin RJ, Eder A, Draper NL, AuBuchon JP, León de González G. Inventory management. Vox Sang 2010; 98:e295-363. [PMID: 20432515 DOI: 10.1111/j.1423-0410.2009.01252.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A critical aspect of blood transfusion is the timely provision of high quality blood products. This task remains a significant challenge for many blood services and blood systems reflecting the difficulty of balancing the recruitment of sufficient donors, the optimal utilization of the donor's gift, the increasing safety related restrictions on blood donation, a growing menu of specialized blood products and an ever-growing imperative to increase the efficiency of blood product provision from a cost perspective. As our industry now faces questions about our standard practices including whether or not the age of blood has a negative impact on recipients, it is timely to take a look at our collective inventory management practices. This International Forum represents an effort to get a snap shot of inventory management practices around the world, and to understand the range of different products provided for patients. In addition to sharing current inventory management practices, this Forum is intended to foster an exchange of ideas around where we see our field moving with respect to various issues including specialty products, new technologies, and reducing recipient risk from blood transfusion products.
Collapse
|
14
|
Reesink HW, Engelfriet CP, Schennach H, Gassner C, Wendel S, Fontão-Wendel R, de Brito MA, Sistonen P, Matilainen J, Peyrard T, Pham BN, Rouger P, Le Pennec PY, Flegel WA, von Zabern I, Lin CK, Tsoi WC, Hoffer I, Barotine-Toth K, Joshi SR, Vasantha K, Yahalom V, Asher O, Levene C, Villa MA, Revelli N, Greppi N, Marconi M, Tani Y, Folman CC, de Haas M, Koopman MMW, Beckers E, Gounder DS, Flanagan P, Wall L, Aranburu Urtasun E, Hustinx H, Niederhauser C, Flickinger C, Nance SJ, Meny GM. Donors with a rare pheno (geno) type. Vox Sang 2008; 95:236-53. [PMID: 19121189 DOI: 10.1111/j.1423-0410.2008.01084.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
15
|
Aldred MP, Contoret AEA, Farrar SR, Kelly SM, Mathieson D, O'Neill M, Tsoi WC, Vlachos P. A Full-Color Electroluminescent Device and Patterned Photoalignment Using Light-Emitting Liquid Crystals. Adv Mater 2005; 17:1368-1372. [PMID: 34412426 DOI: 10.1002/adma.200500258] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2005] [Accepted: 02/25/2005] [Indexed: 06/13/2023]
Abstract
Blue, green, and red polymerizable light-emitting liquid crystals have been patterned photolithographically in a full-color liquid-crystal electroluminescent display. A new hole-transporting photoalignment copolymer is also reported and the spatial patterning of the polarization direction of emission is demonstrated.
Collapse
Affiliation(s)
- M P Aldred
- Department of Chemistry, University of Hull, Cottingham Rd., Hull HU6 7RX, UK
| | | | - S R Farrar
- Department of Physics, University of Hull, Cottingham Rd., Hull HU6 7RX, UK
| | - S M Kelly
- Department of Chemistry, University of Hull, Cottingham Rd., Hull HU6 7RX, UK
| | - D Mathieson
- Department of Physics, University of Hull, Cottingham Rd., Hull HU6 7RX, UK
| | - M O'Neill
- Department of Physics, University of Hull, Cottingham Rd., Hull HU6 7RX, UK
| | - W C Tsoi
- Department of Physics, University of Hull, Cottingham Rd., Hull HU6 7RX, UK
| | - P Vlachos
- Department of Chemistry, University of Hull, Cottingham Rd., Hull HU6 7RX, UK
| |
Collapse
|
16
|
Abstract
Safety in blood transfusion has all along been focused on blood borne viruses like HIV, hepatitis B and C. However, infective agents that are not usually transmitted through blood may also pose risk to transfusion if the donor gives blood in the early-viraemic phase. A case report of potential transfusion-transmitted hepatitis E (HEV) is described. It shows the virus can be transmissible via blood because of the presence of HEV RNA in the blood donated. Pre-donation health screening was unable to exclude this asymptomatic donor. But donor-initiated call back system which acts as an additional safety net prevented the release of the potential infective blood products.
Collapse
Affiliation(s)
- C K Lee
- Hong Kong Red Cross Blood Transfusion Service, Hong Kong.
| | | | | | | | | | | |
Collapse
|
17
|
Abstract
BACKGROUND The use of bacterial culture to prevent bacterial contamination of blood components has renewed interest for extending the shelf life of PLT concentrates to 7 days after collection. STUDY DESIGN AND METHODS This study was therefore conducted to determine the residual risk of bacterial contamination in PLT concentrates at the end of 5 and 7 days after collection in a center where all PLT concentrates are routinely screened by taking samples on Day 2 for culture. PLT units with no growth after 48 hours were sampled a second time on Day 5 or Day 7 after collection, followed by inoculation into aerobic culture bottles. The inoculated bottles were then monitored for up to 7 days at 35 degrees C in an automatic monitoring and detection system. RESULTS During a 16-month study period, a total of 6020 PLT concentrates were tested 5 days (Group A, n=3010) and 7 days (Group B, n=3010) after collection. Four units in each group (0.133%) were found to be contaminated. In 6 units, bacteria were seen on direct Gram stain. In addition, 5 of the associated RBC units grew the same organisms on culture. The organisms include three coagulase-negative staphylococci and five Propionibacterium acnes. The positive rate of routine short-term bacterial culture was 0.035 percent during the same study period. CONCLUSION Despite routine short-term bacterial culture, a significant risk of bacterial contamination remains at 5 and 7 days after collection. For now, the shelf life of PLT concentrates should remain 5 days.
Collapse
Affiliation(s)
- C K Lee
- Hong Kong Red Cross Blood Transfusion Service and Center of Infection and Department of Microbiology, the University of Hong Kong, Hong Kong.
| | | | | | | | | | | | | |
Collapse
|
18
|
Chui CH, Lau FY, Wong R, Soo OY, Lam CK, Lee PW, Leung HK, So CK, Tsoi WC, Tang N, Lam WK, Cheng G. Vitamin B12 deficiency--need for a new guideline. Nutrition 2001; 17:917-20. [PMID: 11744340 DOI: 10.1016/s0899-9007(01)00666-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [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: 10/17/2022]
Abstract
OBJECTIVES Many patients with vitamin B12 deficiency do not have anemia or macrocytosis, but the prevalence of B12 deficiency in patients without macrocytosis is not known. METHODS We investigated the prevalence of B12 deficiency among patients with normocytosis and microcytosis and recommended a screening strategy. All patients (n = 3714) with serum B12 measured at the Prince of Wales Hospital in 1996 were reviewed. The prevalence of serum B12 less than 140 pmol/L was determined for the following patient subgroups: younger than 70 y, older than 70 y, anemic, non-anemic, macrocytic, normocytic, microcytic, documented iron deficiency, and documented thalassemia. RESULTS The prevalence of B12 deficiency (<140 pmol/L) ranged from 4.8% to 9.8% among the different subgroups. CONCLUSIONS Whatever screening criteria were used, a significant number of B12-deficient patients will be missed. Therefore, there may be a case for universal vitamin B12 screening.
Collapse
Affiliation(s)
- C H Chui
- Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, People's Republic of China
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Tsang KS, Li CK, Chik KW, Shing MM, Tsoi WC, Ng MH, Lau TT, Leung Y, Yuen PM. TEL/AML1 rearrangement and the prognostic significance in childhood acute lymphoblastic leukemia in Hong Kong. Am J Hematol 2001; 68:91-8. [PMID: 11559948 DOI: 10.1002/ajh.1159] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [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: 01/06/2023]
Abstract
The TEL/AML1 rearrangement has been implicated as an independent good prognostic factor in pediatric acute lymphoblastic leukemia (ALL). We examined TEL/AML1 using nested reverse-transcription polymerase chain reaction (RT-PCR) and correlated TEL/AML1 with cytogenetics and immunophenotypes in 75 consecutively analyzed Chinese children with ALL in Hong Kong. TEL/AML1 was detected in 17.9% (12/67) B-lineage ALL at diagnosis but not in 8 T-ALL children or in 34 adults with ALL. E2A/PBX1, MLL/AF4, and BCR/ABL were not found in TEL/AML1+ patients. Coexpression of cross-lineage antigens was associated with TEL/AML1 gene fusion (p = 0.032), with CD13 in 80% (4/5) TEL/AML1+ cohort. Chromosomal abnormalities were demonstrated in 50% of the TEL/AML1+ ALL; however, a cryptic t(12;21) was not detected in these cases. Hyperdiploidy of 47-48 chromosomes was encountered in 25%. Deletion of 12p resulting in the loss of the normal allele of TEL and nonspecific del(6q) were noted in 8% (1/12) and 25% (3/12) of the TEL/AML1+ children, respectively. Rapid clearance of TEL/AML1 was noted in 50% of the patients on completion of the induction therapy; however, 16.7% (2/12) TEL/AML1+ ALL relapsed at a mean of 48.6 months from diagnosis (25 months off-therapy). The incidence of relapses of TEL/AML1+ ALL was comparable to that at diagnosis in B-lineage ALL (14.3% [2/14] vs. 17.9% [12/67], p > 0.05). The relapse rate in TEL/AML1+ ALL was similar to that of TEL/AML1- ALL (16.7% [2/12] vs. 20.6% [13/63], p > 0.05). The duration of first complete remission in TEL/AML1+ ALL was significantly longer as compared to TEL/AML1- ALL (mean [range] in month: 48.6 [47.2 - 50] vs 14.6 [2.9 - 42.3], p < 0.0001). Irrespective of TEL/AML1 rearrangement, the probabilities of the five-year overall survival and the event-free survival of patients were comparable (overall survival: 100% vs. 72.3%, p = 0.166 and event-free survival: 60% vs. 56.2%, p = 0.343). Our data would not suggest a less aggressive treatment regimen for TEL/AML1+ ALL.
Collapse
Affiliation(s)
- K S Tsang
- Hematology and Bone Marrow Transplantation Division, Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong, China
| | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Wong A, Yuen PM, Li K, Yu AL, Tsoi WC. Cord blood collection before and after placental delivery: levels of nucleated cells, haematopoietic progenitor cells, leukocyte subpopulations and macroscopic clots. Bone Marrow Transplant 2001; 27:133-8. [PMID: 11281381 DOI: 10.1038/sj.bmt.1702757] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.5] [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: 11/09/2022]
Abstract
The number of nucleated cells infused into the recipient of a cord blood (CB) transplant has emerged as the most important factor affecting the probability and speed of engraftment. At present, there is no international consensus on the procedure of CB collection in the maternity ward. In order to maximise the yield of viable cells in a CB unit, we aimed to investigate the efficiency of CB collection, with respect to the time of delivery of the placenta. We analysed stem and progenitor cells in terms of CD34+ cell content and colony-forming activities, lymphocyte subpopulations and the presence of macroscopic clots in 93 paired CB samples, collected before and after the delivery of the placenta. Our results demonstrated that the median concentrations of nucleated cells and total colony-forming unit (CFU) were significantly lower in CB collected after placenta delivery by 9.5% (P < 0.001) and 11.6% (P = 0.015), respectively, when compared to their counterparts collected before placental delivery. A reduction of granulocytes (P < 0.001), monocytes (P < 0.001) and CD19+ B lymphocytes (P = 0.031) was observed, with no significant change in the proportion of T cell subsets (CD4+, CD8+ cells) or activated T cells (CD25+, CD45RO+ cells) in samples collected after placenta delivery. The incidence of macroscopic clots was also higher in these samples (31% vs 1%, P < 0.001). The reduction of stem and progenitor cells correlated significantly with that of major cell populations, indicating a general cell loss, possibly due to clotting activities developed with time. Our study has documented strong evidence for recommending the collection of CB before the delivery of the placenta.
Collapse
Affiliation(s)
- A Wong
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, NT
| | | | | | | | | |
Collapse
|
21
|
Affiliation(s)
- W C Tsoi
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Shatin New Territories, Hong Kong
| | | | | | | |
Collapse
|
22
|
Abstract
We describe a 15-y-old girl with Fechtner-like syndrome, who is the first Chinese reported to have this rare syndrome. She presented with left homonymous hemianopia and neuroimaging revealed haemorrhage in both parietal and occipital lobes. Peripheral blood smear showed macrothrombocytopenia and intracytoplasmic inclusion bodies inside leucocytes. Thrombocytopenia and proteinuria responded to intravenous immunoglobulin and pulsed methylprednisolone. This case illustrates that life-threatening haemorrhage can occur in patients with Fechtner syndrome. Although there was no effective treatment reported in the literature, high dose steroid and immunoglobulin seemed to be useful in our patient. Our patient also had nephritic-nephrotic syndrome with renal insufficiency, which is unusual in adolescent female patients.
Collapse
Affiliation(s)
- T F Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin
| | | | | | | | | | | |
Collapse
|
23
|
|
24
|
Abstract
OBJECTIVE Primary brain tumours may be associated with coagulation disorders which can pose intraoperative and postoperative management difficulties. The aim was to evaluate the coagulation profile of patients with brain tumours undergoing surgery using thromboelastography (TEG) in combination with simple laboratory tests. METHODS Fifty adult patients with primary brain tumours larger than 4 cm in maximum diameter and no history of coagulation disorders were studied in a prospective, observational manner over a one year period. Preoperative, intraoperative, and postoperative measurements included haemoglobin concentration, platelet count, prothrombin and partial thromboplastin times, fibrin(ogen) degradation product concentration, D-dimer concentration, and TEG. RESULTS Eleven patients (22%) had abnormal intraoperative TEGs, of whom six (12%) subsequently developed haematomas requiring surgical evacuation. The coagulopathy seemed to be hyperfibrinolysis in two cases (4%) and disseminated intravascular coagulation in four (8%). There was no preoperative difference in reaction time (R time) for clot formation between the non-haematoma and haematoma groups(mean 11.44 (SD 3.42) v 12.33 (2.50) min, P=0.46). However, when other preoperative indices were compared, in the non-haematoma group, K time (time to reach a clot amplitude of 20 mm) was shorter (6.72 (2.15) v 10.56 (3.50) min, P=0.001), rate of clot growth (å) was faster (43.67 degrees (7.53) v 27.11 degrees (5.42), P<0.0001) and maximum amplitude of clot strength (MA) was greater (52.64 (7.85) v 40.33 (6.59) mm, P<0.001). Intraoperatively, R time was significantly shortened in the non-haematoma group, (7.67 (1.78) min, P<0.0001) unlike the haematoma group (10.67 (1.58) minutes, P=0.11). CONCLUSIONS Although these results indicate a general hypercoagulability during brain tumour surgery, in certain cases, a predisposition towards hypocoagulability may exist even before surgery, detectable only when the physical characteristics of clot formation are studied by TEG. Judicious replacement of clotting factors, platelets, and antifibrinolytic agents should be considered intraoperatively if the TEG is abnormal, without waiting for laboratory test results.
Collapse
Affiliation(s)
- K Y Goh
- Department of Surgery, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories
| | | | | | | | | |
Collapse
|
25
|
Abstract
Warfarin requirements are lower in the Chinese, but it is not known if this applies to heparin. We investigated the optimal dose for heparin therapy in Chinese patients, and to assess relationship between i.v. heparin dosage and anticoagulation efficacy. One hundred Chinese patients requiring intravenous heparin therapy were given an initial bolus followed by continuous intravenous infusion. The main outcome measures were: (i) Efficacy of anticoagulation assessed by blood coagulation studies (APTT) compared to heparin dosage, (ii) Determinants of dosage variation-age, gender, body weight, height, indication for heparin therapy and number of medications, other disease, and serum albumin level. It was found that the mean therapeutic infusion dose requirement of heparin was 848.7 +/- 274.7 units/h, 79% required a dose of 1000 units/h or less. Heparin dose correlated negatively with age (r = -0.40; p < 0.001) and positively with weight (r = 0.44 p < 0.001) and height (r = 0.49; p < 0.001). Chinese subjects require lower heparin doses (about 800 units/h) than usually recommended for Caucasians (usual dose 1000-1500 units/h). This can be partly explained by the lower body weight in Chinese patients.
Collapse
Affiliation(s)
- C M Yu
- Department of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong
| | | | | | | |
Collapse
|
26
|
|
27
|
Tsoi WC, Feng CS. Hemophagocytosis by rhabdomyosarcoma cells in bone marrow. Am J Hematol 1997; 54:340-2. [PMID: 9092697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
|
28
|
Tsoi WC, Feng CS. Clumping of plasma cells: a pitfall in the diagnosis of plasma cell leukemia. Am J Hematol 1997; 54:174-5. [PMID: 9034300 DOI: 10.1002/(sici)1096-8652(199702)54:2<174::aid-ajh18>3.0.co;2-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
|
29
|
|
30
|
Shing MM, Yuen PM, Li CK, Chik KW, Lai HD, Tsang KS, Ng MH, Tsoi WC. A more immunosuppressive pre-transplant conditioning may be required for Chinese patients with thalassaemia. Bone Marrow Transplant 1996; 17:907-10. [PMID: 8807092] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Bone marrow transplantation was performed on 14 Chinese patients with transfusion dependent thalassaemia major (n = 13) and haemoglobin H disease (n = 1). The donors were HLA identical siblings. The source of haematopoietic stem cells were from bone marrow (n = 13) and umbilical cord blood (n = 1). The pre-transplant conditioning regimens were (1) busulphan 14 mg/kg and cyclophosphamide 200 mg/kg in two patients; (2) busulphan 16 mg/kg, cyclophosphamide 200 mg/kg and anti-thymocyte globulin 110 mg/kg in five patients; (3) busulphan 16 mg/kg, cyclophosphamide 150 mg/kg and anti-thymocyte globulin 110 mg/kg in seven patients. Graft-versus-host disease prophylaxis was cyclosporin A and methotrexate. All patients engrafted and achieved stable haematopoiesis except the one who underwent the umbilical cord blood transplant, who had autologous marrow recovery. One patient who had stable engraftment rejected the marrow graft and developed aplastic anaemia 4 months after BMT. This patient had a second BMT but rejection recurred again. She eventually died of septicaemia. The other 12 patients were transfusion independent and disease free. The majority have gone back to school or work. Disease-free and actuarial survival probability were 85 and 93%, respectively with a median follow-up time of 30 months (13 to 42 months). Our data suggest that BMT from HLA identical siblings for transfusion dependent thalassaemia gives a high chance of cure with acceptable mortality and morbidity, and that a more immunosuppressive pre-transplant conditioning schedule may be required to prevent rejection.
Collapse
Affiliation(s)
- M M Shing
- Department of Paediatrics, Lady Pao Children's Cancer Centre, Prince of Wales Hospital, Chinese University of Hong Kong
| | | | | | | | | | | | | | | |
Collapse
|
31
|
Tsoi WC, Feng CS, Chew EC. Plasma cells with iron inclusions in two non-alcoholic Chinese women. Pathology 1996; 28:125-7. [PMID: 8743815 DOI: 10.1080/00313029600169713] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Plasma cells with iron granules are rare, especially among non-alcoholic individuals. We report two teetotaller Chinese women with nasopharyngeal carcinoma and non-Hodgkin's lymphoma, whose bone marrow studies revealed plasma cells with inclusions morphologically compatible with iron granules. The iron nature of the granules was confirmed by elemental analysis. The clinical significance and the exact mechanism of formation of these iron inclusions in plasma cells remain unknown.
Collapse
Affiliation(s)
- W C Tsoi
- Department of Anatomical and Cellular Pathology, Chinese University of Hong Kong, Shatin
| | | | | |
Collapse
|
32
|
Yeo W, Wong N, Chow J, Tsoi WC, Johnson PJ, Wickham N. Small cell variant of Ki-1 lymphoma associated with myelofibrosis and a novel constitutional chromosomal translocation t(3;4) (q13;q12). J Clin Pathol 1996; 49:259-62. [PMID: 8675743 PMCID: PMC500412 DOI: 10.1136/jcp.49.3.259] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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: 02/01/2023]
Abstract
An unusual case of small cell variant of Ki-1 non-Hodgkin's lymphoma diagnosed one year after an original diagnosis of idiopathic myelofibrosis is reported. On the second occasion, the patient presented with fever, lymphadenopathy and hepatosplenomegaly. A lymph node biopsy specimen confirmed a diagnosis of small cell variant of Ki-1 lymphoma. A repeat bone marrow biopsy specimen showed myelofibrosis with no evidence of lymphomatous infiltration, but cytogenetic studies on blood, bone marrow and skin fibroblasts revealed a novel chromosomal translocation t(3,4)(q13;q12).
Collapse
MESH Headings
- Chromosome Mapping
- Chromosomes, Human, Pair 12
- Chromosomes, Human, Pair 13
- Chromosomes, Human, Pair 3/genetics
- Chromosomes, Human, Pair 4/genetics
- Humans
- Lymphoma, Large-Cell, Anaplastic/complications
- Lymphoma, Large-Cell, Anaplastic/genetics
- Lymphoma, Large-Cell, Anaplastic/pathology
- Male
- Middle Aged
- Primary Myelofibrosis/complications
- Translocation, Genetic
Collapse
Affiliation(s)
- W Yeo
- Department of Clinical Oncology, Chinese University of Hong Kong
| | | | | | | | | | | |
Collapse
|
33
|
Abstract
An 8 yr old Chinese girl was investigated for easy bruising and mild thrombocytopenia. Platelet aggregation studies and coagulation tests were found to be normal. The giant platelets and Döhle-like cytoplasmic inclusions in granulocytes confirmed the diagnosis of May-Hegglin anomaly. The father's granulocytes also had Döhle-like inclusions and one paternal aunt had a history of bleeding tendency. Review of literature showed that such Döhle-like inclusions had always been described morphologically as crescentic or spindle-shaped. In this case, however, the shape was roundish, oval or poorly defined. Ultrastructurally, the classic description was electron-dense long rods and needles orientating along the long axis of the "spindle". In this case, the only electron-dense particles were dot-like with a haphazard arrangement.
Collapse
Affiliation(s)
- W C Tsoi
- Department of Anatomical and Cellular Pathology, Prince of Wales Hospital, Shatin, Hong Kong
| | | | | | | |
Collapse
|
34
|
Kwong YL, Shing MK, Tsoi WC, Wan TS, Yuen PM, Chan LC. Association between t(2;9)(p12;p23) and early B-precursor acute lymphoblastic leukemia. Cancer Genet Cytogenet 1993; 69:163-4. [PMID: 8402560 DOI: 10.1016/0165-4608(93)90098-7] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
We report the occurrence of t(2;9)(p12;p23) in a 20-month-old girl with early B-precursor acute lymphoblastic leukemia (ALL). This translocation has only been reported once before in an adult case of early B-precursor ALL with t(4;11)(q21;q23). We suggest that t(2;9)(p12;p23) may be associated with this particular phenotype of ALL.
Collapse
Affiliation(s)
- Y L Kwong
- University Department of Pathology, Queen Mary Hospital, Hong Kong
| | | | | | | | | | | |
Collapse
|