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Callum J, Skubas NJ, Bathla A, Keshavarz H, Clark EG, Rochwerg B, Fergusson D, Arbous S, Bauer SR, China L, Fung M, Jug R, Neill M, Paine C, Pavenski K, Shah PS, Robinson S, Shan H, Szczepiorkowski ZM, Thevenot T, Wu B, Stanworth S, Shehata N. Use of Intravenous Albumin: A Guideline From the International Collaboration for Transfusion Medicine Guidelines. Chest 2024:S0012-3692(24)00285-X. [PMID: 38447639 DOI: 10.1016/j.chest.2024.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Albumin is used commonly across a wide range of clinical settings to improve hemodynamics, to facilitate fluid removal, and to manage complications of cirrhosis. The International Collaboration for Transfusion Medicine Guidelines developed guidelines for the use of albumin in patients requiring critical care, undergoing cardiovascular surgery, undergoing kidney replacement therapy, or experiencing complications of cirrhosis. METHODS Cochairs oversaw the guideline development process and the panel included researchers, clinicians, methodologists, and a patient representative. The evidence informing this guideline arises from a systematic review of randomized clinical trials and systematic reviews, in which multiple databases were searched (inception through November 23, 2022). The panel reviewed the data and formulated the guideline recommendations using Grading of Recommendations Assessment, Development and Evaluation methodology. The guidelines were revised after public consultation. RESULTS The panel made 14 recommendations on albumin use in adult critical care (three recommendations), pediatric critical care (one recommendation), neonatal critical care (two recommendations), cardiovascular surgery (two recommendations), kidney replacement therapy (one recommendation), and complications of cirrhosis (five recommendations). Of the 14 recommendations, two recommendations had moderate certainty of evidence, five recommendations had low certainty of evidence, and seven recommendations had very low certainty of evidence. Two of the 14 recommendations suggested conditional use of albumin for patients with cirrhosis undergoing large-volume paracentesis or with spontaneous bacterial peritonitis. Twelve of 14 recommendations did not suggest albumin use in a wide variety of clinical situations where albumin commonly is transfused. CONCLUSIONS Currently, few evidence-based indications support the routine use of albumin in clinical practice to improve patient outcomes. These guidelines provide clinicians with actionable recommendations on the use of albumin.
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Affiliation(s)
- Jeannie Callum
- Department of Pathology and Molecular Medicine, Queen's University and Kingston Health Sciences Centre, Kingston.
| | - Nikolaos J Skubas
- Department of Cardiothoracic Anesthesiology, Anesthesiology Institute, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland
| | | | | | - Edward G Clark
- Division of Nephrology, University of Ottawa, Ottawa Hospital Research Institute, Ottawa
| | - Bram Rochwerg
- Department of Medicine and Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton
| | - Dean Fergusson
- Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, Ottawa
| | - Sesmu Arbous
- Department of Critical Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Seth R Bauer
- Department of Pharmacy, Cleveland Clinic, Cleveland
| | - Louise China
- Department of Hepatology and ILDH, The Royal Free NHS Trust and University College London, London
| | - Mark Fung
- Department of Pathology and Laboratory Medicine, University of Vermont Medical Center, Burlington, VT
| | - Rachel Jug
- University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Cary Paine
- Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA
| | - Katerina Pavenski
- Department of Laboratory Medicine and Pathobiology, Mount Sinai Hospital, Toronto, ON
| | - Prakesh S Shah
- Institute of Health Policy, Management, and Evaluation, Mount Sinai Hospital, Toronto, ON; Department of Pediatrics, Mount Sinai Hospital, Toronto, ON
| | - Susan Robinson
- Department of Clinical Haematology, Guy's and St Thomas' NHS Foundation Trust, London
| | - Hua Shan
- Department of Pathology, Stanford University School of Medicine, Palo Alto
| | | | - Thierry Thevenot
- Service d'Hépatologie, Centre Hospitalier Régional et Universitaire de Besançon, Besançon, France
| | - Bovey Wu
- Department of Internal Medicine, Graduate Medical Education, Loma Linda University, Loma Linda, CA
| | - Simon Stanworth
- NHS Blood and Transplant, Oxford, England; Radcliffe Department of Medicine, University of Oxford, Oxford, England; John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, England
| | - Nadine Shehata
- Department of Medicine, University of Toronto, Mount Sinai Hospital, Toronto, ON; Transfusion Medicine Laboratory, Mount Sinai Hospital, Toronto, ON
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2
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Karafin MS, DeSimone RA, Dvorak J, Metcalf RA, Pagano MB, Park YA, Schwartz J, Souers RJ, Szczepiorkowski ZM, Uhl L, Ramsey G. Antibody Titers in Transfusion Medicine: A Critical Reevaluation of Testing Accuracy, Reliability, and Clinical Use. Arch Pathol Lab Med 2023; 147:1351-1359. [PMID: 36730468 DOI: 10.5858/arpa.2022-0248-cp] [Citation(s) in RCA: 1] [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] [Accepted: 10/17/2022] [Indexed: 02/04/2023]
Abstract
CONTEXT.— Substantial variability between different antibody titration methods has been identified since the development and introduction of the uniform procedure in 2008. OBJECTIVE.— To determine whether more recent methods or techniques decrease interlaboratory and intralaboratory variation measured using proficiency testing. DESIGN.— Proficiency test data for antibody titration between 2014 and 2018 were obtained from the College of American Pathologists. Interlaboratory and intralaboratory variations were compared by analyzing the distribution of titer results by method and phase, comparing the results against the supplier's quality control titer, and by evaluating the distribution of paired titer results when each laboratory received a sample with the same titer twice. RESULTS.— A total of 1337 laboratories participated in the antibody titer proficiency test during the study period. Only 54.1% (5874 of 10 852) of anti-D and 63.4% (3603 of 5680) of anti-A reported responses were within 1 titer of the supplier's intended result. Review of the agreement between laboratories of the same methodology found that 78.4% (3139 of 4004) for anti-A and 89.0% (9655 of 10 852) of laboratory responses for anti-D fell within 1 titer of the mode response. When provided with 2 consecutive samples of the same titer (anti-D titer: 16), 85% (367 of 434) of laboratories using the uniform procedure and 80% (458 of 576) using the other method reported a titer difference of 1 or less. CONCLUSIONS.— Despite advances, interlaboratory and intralaboratory variance for this assay remains high in comparison with the strong reliance on titer results in clinical practice. There needs to be a reevaluation of the role of this test in clinical decision-making.
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Affiliation(s)
- Matthew S Karafin
- From the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Karafin, Park)
| | - Robert A DeSimone
- The Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center, New York, New York (DeSimone)
| | - James Dvorak
- Proficiency Testing (Dvorak), College of American Pathologists, Northfield, Illinois
| | - Ryan A Metcalf
- ARUP Laboratories, Department of Pathology, University of Utah School of Medicine, Salt Lake City (Metcalf)
| | - Monica B Pagano
- The Department of Laboratory Medicine, University of Washington Medical Center, Seattle (Pagano)
| | - Yara A Park
- From the Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Karafin, Park)
| | - Joseph Schwartz
- The Department of Pathology, Molecular & Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York (Schwartz)
| | - Rhona J Souers
- Biostatistics (Souers), College of American Pathologists, Northfield, Illinois
| | - Zbigniew M Szczepiorkowski
- The Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire (Szczepiorkowski)
| | - Lynne Uhl
- The Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts (Uhl)
| | - Glenn Ramsey
- The Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Ramsey)
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3
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Lachert E, Antoniewicz-Papis J, Mikołowska A, Kubis J, Szczepiorkowski ZM, Łętowska M. Introduction of EUBIS standards to upgrade inspections of blood establishments to improve the safety of blood transfusion: The Polish experience. Transfus Med 2023; 33:460-466. [PMID: 37732379 DOI: 10.1111/tme.13007] [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: 07/11/2023] [Accepted: 09/09/2023] [Indexed: 09/22/2023]
Abstract
BACKGROUND AND OBJECTIVES The competent authority (CA) responsible for external inspections of Polish blood establishments (BEs) and supervision of the quality system is the Institute of Haematology and Transfusion Medicine (IHTM). Before the implementation of the European Blood Inspection System (EuBIS) classification of non-compliance, the IHTM inspections were conducted according to national guidelines and the non-compliance-related recommendations were based on the inspectors' own experience and interpretation of the observed problems. Since 2009, IHTM inspections were already performed according to EuBIS guidelines. The study assessed the impact of the EuBIS classification on the IHTM recommendations. We assumed that the implementation of consistent assessment criteria contributed to the upgrading of the quality of BE inspections. MATERIALS AND METHODS BE-inspection protocols; 30 from 2009 to 2010 and 61 from 2016 to 2019. Non-compliance-related recommendations were classified according to the seriousness of non-compliances (critical, major, other significant, and observation) and also to the area of BE activity (documentation, organisation of work, qualification and validation, pathway from donor qualification to blood component-issue, quality control of blood components, adverse events and reactions). RESULTS The recommendations mostly referred to document-keeping and work organisation and were distributed as follows: 2009-2 critical (others unclassified), 2010-1-13 major, 4-25 other significant and 1-7 suggestions, 2016-2019-3-9 critical, 90-196 major, and 157-297 other significant as well as 14-22 suggestions. CONCLUSION Polish BEs still require: integrated document management, analysis of IHTM recommendations, implementation of corrective and preventive measures and personnel training in identifying similar non-compliances in other procedures.
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Affiliation(s)
- Elżbieta Lachert
- Department of Transfusion Medicine, Institute of Hematology and Transfusion Medicine (IHTM), Warsaw, Poland
| | - Jolanta Antoniewicz-Papis
- Department of Transfusion Medicine, Institute of Hematology and Transfusion Medicine (IHTM), Warsaw, Poland
| | - Agata Mikołowska
- Department of Transfusion Medicine, Institute of Hematology and Transfusion Medicine (IHTM), Warsaw, Poland
| | - Jolanta Kubis
- Department of Transfusion Medicine, Institute of Hematology and Transfusion Medicine (IHTM), Warsaw, Poland
| | - Zbigniew M Szczepiorkowski
- Department of Transfusion Medicine, Institute of Hematology and Transfusion Medicine (IHTM), Warsaw, Poland
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Magdalena Łętowska
- Department of Transfusion Medicine, Institute of Hematology and Transfusion Medicine (IHTM), Warsaw, Poland
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4
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Grifols C, Barceló M, Núñez L, Szczepiorkowski ZM, Boada M, López OL, Páez A. Impact of therapeutic and low volume plasma exchange on clinical laboratory parameters in patients treated for Alzheimer's disease from the AMBAR study. Ther Apher Dial 2023; 27:949-959. [PMID: 37211527 DOI: 10.1111/1744-9987.14002] [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: 09/29/2022] [Revised: 12/20/2022] [Accepted: 05/06/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Little is known about the impact of plasma exchange (PE) on clinical laboratory parameters in Alzheimer's disease (AD) patients. METHODS AD patients in the AMBAR trial (N = 322) received weekly therapeutic PE (TPE) for 6 weeks followed by monthly low-volume PE (LVPE) for12 months. Treatment were placebo (sham PE), low-albumin, low-albumin + IVIG (i.e., albumin alternated with intravenous immunoglobulin) and high-albumin + IVIG. RESULTS Coagulation parameters transiently increased post-TPE. Blood calcium, platelets, and albumin levels decreased but remained within the reference range. Leukocyte counts increased. Fibrinogen, hemoglobin, total protein, gamma globulin, and IgG, transiently dipped below the reference range. Hypogammaglobulinemia (7.2 g/L) persisted in pre-TPE measurements. No changes were observed during the LVPE period. Cerebrospinal fluid parameters and vital signs were unchanged throughout. CONCLUSION Laboratory parameters of AD patients were affected by TPE similarly to effects of PE-treatment for other pathologies. These effects were less pronounced or non-existent for LVPE.
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Affiliation(s)
| | - Miquel Barceló
- Alzheimer's Research Group, Grifols S.A., Barcelona, Spain
| | - Laura Núñez
- Alzheimer's Research Group, Grifols S.A., Barcelona, Spain
| | - Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
- Division of Transfusion Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Mercè Boada
- Ace Alzheimer Center Barcelona, Universitat Internacional de Catalunya, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Oscar L López
- Departments of Neurology and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Antonio Páez
- Alzheimer's Research Group, Grifols S.A., Barcelona, Spain
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5
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Boada M, Kiprov D, Anaya F, López OL, Núñez L, Olazarán J, Lima J, Grifols C, Barceló M, Rohe R, Prieto-Fernández C, Szczepiorkowski ZM, Páez A. Feasibility, safety, and tolerability of two modalities of plasma exchange with albumin replacement to treat elderly patients with Alzheimer's disease in the AMBAR study. J Clin Apher 2023; 38:45-54. [PMID: 36305459 PMCID: PMC10092802 DOI: 10.1002/jca.22026] [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: 05/17/2022] [Revised: 09/14/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In the Alzheimer Management by Albumin Replacement (AMBAR) study, mild-to-moderate Alzheimer's disease (AD) patients were treated with a plasma exchange (PE) program. Feasibility and safety of PE in this specific population are poorly understood and were analyzed in detail in this study. METHODS Qualified patients were treated with 6 weeks of weekly conventional therapeutic plasma exchange (TPE) with albumin replacement followed by monthly low-volume plasma exchange (LVPE) for 12 months. The patients were divided into four groups: placebo (sham PE treatment), low-albumin (20 g), low-albumin + intravenous immunoglobulin (IVIG) (10 g), and high-albumin (40 g) + IVIG (20 g). Adverse events (AEs) were recorded and analyzed for all PE treatment groups and PE modalities. RESULTS PE procedure-related AEs were more common in the active treatment groups (16.9% out of 1283 TPE and 12.5% out of 2203 LVPE were associated with at least one AE, a similar rate than in other PE indications) than in the placebo group (0.7% out of 1223 sham PE). Percentage of procedures with at least one AEs was higher with central venous access compared to peripheral venous access in all three active treatment groups (20.1% vs 13.1%, respectively). CONCLUSION The TPE and LVPE procedures used in the AMBAR study on mild-to-moderate AD population were as safe and feasible as in other therapeutic applications of PE or routine plasmapheresis.
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Affiliation(s)
- Mercè Boada
- Ace Alzheimer Center Barcelona - Universitat Internacional de Catalunya, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Dobri Kiprov
- Apheresis Care Group and Fresenius Medical Care, San Francisco, California, USA
| | - Fernando Anaya
- Nephrology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Oscar L López
- Departments of Neurology and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Laura Núñez
- Alzheimer's Research Group, Grifols, Barcelona, Spain
| | - Javier Olazarán
- Neurology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Memory Disorders Clinic, HM Hospitales, Madrid, Spain
| | - José Lima
- American Red Cross Southern Blood Services Region, Atlanta, Georgia, USA
| | | | | | - Regina Rohe
- Apheresis Care Group and Fresenius Medical Care, San Francisco, California, USA
| | | | - Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Antonio Páez
- Alzheimer's Research Group, Grifols, Barcelona, Spain
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6
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Ramsey G, Park YA, Eder AF, Bobr A, Karafin MS, Karp JK, King KE, Pagano MB, Schwartz J, Szczepiorkowski ZM, Souers RJ, Thomas L, Delaney M. Obstetric and Newborn Weak D-Phenotype RBC Testing and Rh Immune Globulin Management Recommendations: Lessons From a Blinded Specimen-Testing Survey of 81 Transfusion Services. Arch Pathol Lab Med 2023; 147:71-78. [PMID: 35486492 DOI: 10.5858/arpa.2021-0250-cp] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 12/31/2022]
Abstract
CONTEXT.— Modern RHD genotyping can be used to determine when patients with serologic weak D phenotypes have RHD gene variants at risk for anti-D alloimmunization. However, serologic testing, RhD interpretations, and laboratory management of these patients are quite variable. OBJECTIVE.— To obtain interlaboratory comparisons of serologic testing, RhD interpretations, Rh immune globulin (RhIG) management, fetomaternal hemorrhage testing, and RHD genotyping for weak D-reactive specimens. DESIGN.— We devised an educational exercise in which 81 transfusion services supporting obstetrics performed tube-method RhD typing on 2 unknown red blood cell challenge specimens identified as (1) maternal and (2) newborn. Both specimens were from the same weak D-reactive donor. The exercise revealed how participants responded to these different clinical situations. RESULTS.— Of reporting laboratories, 14% (11 of 80) obtained discrepant immediate-spin reactions on the 2 specimens. Nine different reporting terms were used to interpret weak D-reactive maternal RhD types to obstetricians. In laboratories obtaining negative maternal immediate-spin reactions, 28% (16 of 57) performed unwarranted antiglobulin testing, sometimes leading to recommendations against giving RhIG. To screen for excess fetomaternal hemorrhage after a weak D-reactive newborn, 47% (34 of 73) of reporting laboratories would have employed a contraindicated fetal rosette test, risking false-negative results and inadequate RhIG coverage. Sixty percent (44 of 73) of laboratories would obtain RHD genotyping in some or all cases. CONCLUSIONS.— For obstetric and neonatal patients with serologic weak D phenotypes, we found several critical problems in transfusion service laboratory practices. We provide recommendations for appropriate testing, consistent immunohematologic terminology, and RHD genotype-guided management of Rh immune globulin therapy and RBC transfusions.
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Affiliation(s)
- Glenn Ramsey
- From the Department of Pathology, Northwestern University, Chicago, Illinois (Ramsey)
| | - Yara A Park
- Department of Pathology and Laboratory Medicine, University of North Carolina, Chapel Hill (Park)
| | - Anne F Eder
- Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland (Eder)
| | - Aleh Bobr
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota (Bobr).,Bobr is currently located in the Department of Pathology and Microbiology, at the University of Nebraska Medical Center, Omaha. Karafin is currently located in the Department of Pathology and Laboratory Medicine, at the University of North Carolina, Chapel Hill. Schwartz is currently located in the Department of Pathology, Molecular and Cell-Based Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Julie K Karp
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania (Karp)
| | - Karen E King
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland (King)
| | - Monica B Pagano
- Department of Laboratory Medicine and Pathology, University of Washington, Seattle (Pagano)
| | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Medical Center, New York, New York (Schwartz)
| | - Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth College, Hanover, New Hampshire (Szczepiorkowski)
| | - Rhona J Souers
- Department of Biostatistics (Souers), College of American Pathologists, Northfield, Illinois
| | - Lamont Thomas
- Department of Pathology, Anatomy and Cell Biology, Thomas Jefferson University, Philadelphia, Pennsylvania (Karp).,Department of Proficiency Testing (Thomas), College of American Pathologists, Northfield, Illinois
| | - Meghan Delaney
- The Division of Pathology & Laboratory Medicine, Children's National Hospital, and the Departments of Pathology & Pediatrics, The George Washington University School of Medicine & Health Sciences, Washington, DC (Delaney)
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7
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Ondrasik RM, Khan J, Szczepiorkowski ZM, Levy JJ, Dunbar NM. Passive order auditing associated with reductions in red blood cell utilization: National blood shortage experience. Transfusion 2022; 62:1551-1558. [PMID: 35815525 DOI: 10.1111/trf.17008] [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: 03/18/2022] [Revised: 06/22/2022] [Accepted: 06/22/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Decreased blood collection during the Coronavirus Disease 2019 (COVID-19) pandemic resulted in long-term red blood cell (RBC) shortages in the United States. In an effort to conserve RBCs, the existing passive alert system for auditing inpatient transfusions was modified to activate at a lower hemoglobin threshold (6.5 g/dL instead of 7.0 g/dL for stable, nonbleeding inpatients) during a 9-month shortage at an academic medical center. Hemoglobin levels prior to RBC transfusions were compared for inpatients receiving RBC transfusions to determine whether RBC utilization changed during the intervention. STUDY DESIGN AND METHODS This retrospective study compared the number of single-unit RBC transfusions and hemoglobin levels prior to RBC transfusion among inpatients during the 9 months of the intervention (Period 2, 06/01/2021-2/28/2022) to the same period of the previous year (Period 1, 06/01/2020-2/28/2021). RESULTS Overall full unit RBC transfusions to inpatients decreased by 15% from 5182 to 4421. Of all transfusions, 50.3% and 49.8% were single-unit RBC transfusions in Period 1 and Period 2, respectively. The incidence rate difference and incidence rate ratio of single RBC units transfused per 1000 patient days were significantly decreased (p = 0.0007). The average pre-transfusion hemoglobin level significantly decreased from 7.18 g/dL to 7.05 g/dL (p = 0.0002), largely due to significant decreases in hemoglobin transfusion triggers for adult inpatient ward transfusions. DISCUSSION Modification of the passive alert system was associated with significantly decreased RBC utilization during a long-term RBC shortage. Modification of transfusion criteria recommended by passive alerts may be a feasible option to decrease RBC utilization at centers during long-term RBC shortages.
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Affiliation(s)
- Regina M Ondrasik
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Jenna Khan
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA.,Division of Transfusion Medicine, Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Joshua J Levy
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Department of Pathology and Laboratory Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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8
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Cancelas JA, Genthe JR, Stolla M, Rugg N, Bailey SL, Nestheide S, Shaz B, Mack S, Schroeder K, Anani W, Szczepiorkowski ZM, Dumont LJ, Yegneswaran S, Corash L, Mufti N, Benjamin RJ, Erickson AC. Evaluation of amotosalen and UVA pathogen-reduced apheresis platelets after 7-day storage. Transfusion 2022; 62:1619-1629. [PMID: 35808974 PMCID: PMC9546462 DOI: 10.1111/trf.17003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/15/2022] [Accepted: 05/25/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Amotosalen/UVA pathogen-reduced platelet components (PRPCs) with storage up to 7 days are standard of care in France, Switzerland, and Austria. PRPCs provide effective hemostasis with reduced risk of transfusion-transmitted infections and transfusion-associated graft versus host disease, reduced wastage and improved availability compared with 5-day-stored PCs. This study evaluated the potency of 7-day PRPCs by in vitro characterization and in vivo pharmacokinetic analysis of autologous PCs. STUDY DESIGN AND METHODS The in vitro characteristics of 7-day-stored apheresis PRPCs suspended in 100% plasma or 65% platelet additive solution (PAS-3)/35% plasma, thrombin generation, and in vivo radiolabeled post-transfusion recovery and survival of 7-day-stored PRPCs suspended in 100% plasma were compared with either 7-day-stored or fresh autologous conventional platelets. RESULTS PRPCs after 7 days of storage maintained pH, platelet dose, in vitro physiologic characteristics, and thrombin generation when compared to conventional 7-day PCs. In vivo, the mean post-transfusion survival was 151.4 ± 20.1 h for 7-day PRPCs in 100% plasma (Test) versus 209.6 ± 13.9 h for the fresh autologous platelets (Control), (T-ΔC: 72.3 ± 8.8%: 95% confidence interval [CI]: 68.5, 76.1) and mean 24-h post-transfusion recovery 37.6 ± 8.4% for Test versus 56.8 ± 9.2% for Control (T-ΔC: 66.2 ± 11.2%; 95% CI: 61.3, 71.1). DISCUSSION PRPCs collected in both 100% plasma as well as 65% PAS-3/35% plasma and stored for 7 days retained in vitro physiologic characteristics. PRPCs stored in 100% plasma for 7 days retained in vivo survival. Lower in vivo post-radiolabeled autologous platelet recovery is consistent with reported reduced count increments for allogenic transfusion.
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Affiliation(s)
| | | | - Moritz Stolla
- Bloodworks Northwest, Seattle, Washington, USA.,Division of Hematology, Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Neeta Rugg
- Hoxworth Blood Center, Cincinnati, Ohio, USA
| | | | | | - Beth Shaz
- Duke University, Durham, North Carolina, USA
| | | | | | | | - Zbigniew M Szczepiorkowski
- Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | | | | | - Nina Mufti
- Cerus Corporation, Concord, California, USA
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9
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Boada M, López OL, Olazarán J, Núñez L, Pfeffer M, Puente O, Piñol‐Ripoll G, Gámez JE, Anaya F, Kiprov D, Alegret M, Grifols C, Barceló M, Bozzo J, Szczepiorkowski ZM, Páez A. Neuropsychological, neuropsychiatric, and quality-of-life assessments in Alzheimer's disease patients treated with plasma exchange with albumin replacement from the randomized AMBAR study. Alzheimers Dement 2022; 18:1314-1324. [PMID: 34726348 PMCID: PMC9540900 DOI: 10.1002/alz.12477] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/02/2021] [Accepted: 08/11/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION We report the effects of plasma exchange (PE) with albumin replacement on neuropsychological, neuropsychiatric, and quality-of-life (QoL) outcomes in mild-to-moderate Alzheimer's disease (AD) patients in a phase 2b/3 trial (Alzheimer's Management by Albumin Replacement [AMBAR] study). METHODS Three hundred forty-seven patients were randomized into placebo (sham-PE) and three PE-treatment arms with low/high doses of albumin, with/without intravenous immunoglobulin (IVIG). Specific test measurements were performed at baseline; month 2 (weekly conventional PE); months 6, 9, and 12 (monthly low-volume PE [LVPE]); and month 14. RESULTS The PE-treated mild-AD cohort improved their language fluency and processing speed versus placebo at month 14 (effect sizes: >100%; P-values: .03 to .001). The moderate-AD cohort significantly improved short-term verbal memory (effect sizes: 94% to >100%; P-values: .02 to .003). The progression of the neuropsychiatric symptoms of PE-treated was similar to placebo. Mild-AD patients showed improved QoL (P-values: .04 to .008). DISCUSSION PE-treated AD patients showed improvement in memory, language abilities, processing speed, and QoL-AD. No worsening of their psychoaffective status was observed.
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Affiliation(s)
- Mercè Boada
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades‐Universitat Internacional de CatalunyaBarcelonaSpain
- Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED)Instituto de Salud Carlos IIIMadridSpain
| | - Oscar L. López
- Departments of Neurology and PsychiatryUniversity of Pittsburgh School of MedicinePittsburghPennsylvaniaUSA
| | - Javier Olazarán
- Neurology ServiceHospital General Universitario Gregorio MarañónMadridSpain
- Memory Disorders ClinicHM HospitalesMadridSpain
| | - Laura Núñez
- Alzheimer's Research GroupGrifolsBarcelonaSpain
| | - Michael Pfeffer
- Medical ServicesAllied Biomedical Research Institute, Inc.MiamiFloridaUSA
| | - Orlando Puente
- Center for Prevention of Alzheimer's DiseaseMiami Dade Medical Research InstituteMiamiFloridaUSA
| | - Gerard Piñol‐Ripoll
- Cognitive Disorders UnitClinical Neuroscience ResearchIRB Lleida‐Hospital Universitari Santa MariaLleidaSpain
| | - José E. Gámez
- Psychiatry DepartmentGaliz ResearchHialeahFloridaUSA
| | - Fernando Anaya
- Nephrology ServiceHospital General Universitario Gregorio MarañónMadridSpain
| | - Dobri Kiprov
- Apheresis Care Group and Fresenius Medical CareSan FranciscoCaliforniaUSA
| | - Montserrat Alegret
- Research Center and Memory ClinicFundació ACEInstitut Català de Neurociències Aplicades‐Universitat Internacional de CatalunyaBarcelonaSpain
| | | | | | - Jordi Bozzo
- Alzheimer's Research GroupGrifolsBarcelonaSpain
| | - Zbigniew M. Szczepiorkowski
- Department of Pathology and Laboratory MedicineDartmouth Hitchcock Medical CenterLebanonNew HampshireUSA
- Institute of Hematology and Transfusion MedicineWarsawPoland
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10
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Toledo DM, Robbins AA, Gallagher TL, Hershberger KC, Barney RE, Salmela SM, Pilcher D, Cervinski MA, Nerenz RD, Szczepiorkowski ZM, Tsongalis GJ, Lefferts JA, Martin IW, Hubbard JA. Wastewater-Based SARS-CoV-2 Surveillance in Northern New England. Microbiol Spectr 2022; 10:e0220721. [PMID: 35412387 PMCID: PMC9045146 DOI: 10.1128/spectrum.02207-21] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/03/2022] [Indexed: 12/02/2022] Open
Abstract
SARS-CoV-2 viral RNA is shed in the stool of 55-70% of infected individuals and can be detected in community wastewater up to 7 days before people present with COVID-19 symptoms. The detection of SARS-CoV-2 RNA in wastewater may serve as a lead indicator of increased community transmission. Here, we monitored viral concentrations in samples collected from nine municipal wastewater facilities in New Hampshire (NH) and Vermont (VT).Twenty-four-h composite primary influent wastewater samples were collected from nine municipal wastewater treatment facilities twice per week for 5 months (late September 2020 to early February 2021). Wastewater was centrifuged for 30 min at 4600 × g, then the supernatant was frozen until further analysis. Once thawed, samples were concentrated, extracted, and tested for SARS-CoV-2 RNA using reverse transcriptase-quantitative PCR (RT-qPCR) and reverse transcriptase-droplet digital PCR (RT-ddPCR) detection methods. Active case counts for each municipality were tracked from the NH and VT state COVID-19 dashboards. We received a total of 283 wastewater samples from all sites during the study period. Viral RNA was detected in 175/283 (61.8%) samples using RT-qPCR and in 195/283 (68.9%) samples using RT-ddPCR. All nine sites showed positivity in the wastewater, with 8/9 (88.8%) sites having over 50% of their samples test positive over the course of the study. Larger municipalities, such as Nashua, Concord, and Lebanon, NH, showed that SARS-CoV-2 positivity in the wastewater can precede spikes in active COVID-19 case counts by as much as 7 days. Smaller municipalities, such as Woodsville, NH and Hartford, VT, showed sporadic SARS-COV-2 detection and did not always precede a rise in active case counts. We detected SARS-CoV-2 RNA in samples from all 9 municipalities tested, including cities and small towns within this region, and showed wastewater positivity as an early indicator of active case count increases in some regions. Some of the smaller rural municipalities with low case counts may require more frequent sampling to detect SARS-CoV-2 in wastewater before a case surge. With timely collection and analysis of wastewater samples, a community could potentially respond to results by increasing public health initiatives, such as tightening mask mandates and banning large indoor gatherings, to mitigate community transmission of SARS-CoV-2. IMPORTANCE Despite vaccination efforts, the delta and omicron variants of SARS-CoV-2 have caused global surges of COVID-19. As the COVID-19 pandemic continues, it is important to find new ways of tracking early signs of SARS-CoV-2 outbreaks. The manuscript outlines how to collect wastewater from treatment facilities, concentrate the virus in a dilute wastewater sample, and detect it using two sensitive PCR-based methods. It also describes important trends in SARS-CoV-2 concentration in wastewater of a rural region of the United States from Fall 2020 - Winter 2021 and demonstrates the utility of wastewater monitoring as a leading indicator of active SARS-CoV-2 cases. Monitoring changes in concentration of SARS-CoV-2 virus in wastewater may offer an early indicator of increased case counts and enable appropriate public health actions to be taken.
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Affiliation(s)
- Diana M. Toledo
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- The Broad Institute at MIT and Harvard, Cambridge, Massachusetts, USA
| | - Ashlee A. Robbins
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Torrey L. Gallagher
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Kenneth Chase Hershberger
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Rachael E. Barney
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Sabrina M. Salmela
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Davey Pilcher
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Mark A. Cervinski
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Robert D. Nerenz
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Zbigniew M. Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Gregory J. Tsongalis
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Joel A. Lefferts
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Isabella W. Martin
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Jacqueline A. Hubbard
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
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11
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Ashford P, Allman S, Larsson S, Loper K, Moniz K, Sims-Poston L, Slaper-Cortenbach I, Szczepiorkowski ZM. Standardization of cellular therapy terminology, coding and labeling: a review. Cytotherapy 2022; 24:577-582. [DOI: 10.1016/j.jcyt.2022.02.009] [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] [Received: 10/29/2021] [Revised: 02/04/2022] [Accepted: 02/20/2022] [Indexed: 11/17/2022]
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12
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Viswanathan S, Ciccocioppo R, Galipeau J, Krampera M, Le Blanc K, Martin I, Moniz K, Nolta J, Phinney DG, Shi Y, Szczepiorkowski ZM, Tarte K, Weiss DJ, Ashford P. Consensus International Council for Commonality in Blood Banking Automation-International Society for Cell & Gene Therapy statement on standard nomenclature abbreviations for the tissue of origin of mesenchymal stromal cells. Cytotherapy 2021; 23:1060-1063. [PMID: 34116944 DOI: 10.1016/j.jcyt.2021.04.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 04/13/2021] [Accepted: 04/20/2021] [Indexed: 11/24/2022]
Abstract
The Cellular Therapy Coding and Labeling Advisory Group of the International Council for Commonality in Blood Banking Automation and the International Society for Cell & Gene Therapy mesenchymal stromal cell (MSC) committee are providing specific recommendations on abbreviating tissue sources of culture-adapted MSCs. These recommendations include using abbreviations based on the ISBT 128 terminology model that specifies standard class names to distinguish cell types and tissue sources for culture-adapted MSCs. Thus, MSCs from bone marrow are MSC(M), MSCs from cord blood are MSC(CB), MSCs from adipose tissue are MSC(AT) and MSCs from Wharton's jelly are MSC(WJ). Additional recommendations include using these abbreviations through the full spectrum of pre-clinical, translational and clinical research for the development of culture-adapted MSC products. This does not apply to basic research focused on investigating the developmental origins, identity or functionalities of endogenous progenitor cells in different tissues. These recommendations will serve to harmonize nomenclature in describing research and development surrounding culture-adapted MSCs, many of which are destined for clinical and/or commercial translation. These recommendations will also serve to align research and development efforts on culture-adapted MSCs with other cell therapy products.
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Affiliation(s)
- Sowmya Viswanathan
- Osteoarthritis Research Program, Division of Orthopedic Surgery, Schroeder Arthritis Institute, University Health Network, Toronto, Canada; Krembil Research Institute, University Health Network, Toronto, Canada; Institute of Biomedical Engineering, University of Toronto, Toronto, Canada; Department of Medicine, Division of Hematology, University of Toronto, Toronto, Canada.
| | - Rachele Ciccocioppo
- Department of Medicine, AOUI Policlinico GB Rossi & University of Verona, Verona, Italy
| | - Jacques Galipeau
- Department of Medicine, University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA
| | - Mauro Krampera
- Department of Medicine, Section of Hematology, University of Verona, Verona, Italy
| | - Katarina Le Blanc
- Division of Clinical Immunology and Transfusion Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ivan Martin
- Department of Biomedicine, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Karen Moniz
- International Council for Commonality in Blood Banking Automation, Redlands, California, USA
| | - Jan Nolta
- Department of Internal Medicine, Stem Cell Program and Institute for Regenerative Cures, University of California Davis, Sacramento, California, USA
| | - Donald G Phinney
- Department of Molecular Medicine, The Scripps Research Institute, Jupiter, Florida, USA
| | - Yufang Shi
- The First Affiliated Hospital, Soochow University Institutes for Translational Medicine, Suzhou, China; Institute of Health Sciences, Chinese Academy of Sciences, Shanghai, China
| | - Zbigniew M Szczepiorkowski
- Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA; Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Karin Tarte
- UMR U1236-MICMAC, Immunology and Cell Therapy Lab, Rennes University Hospital, Rennes, France
| | - Daniel J Weiss
- University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Paul Ashford
- International Council for Commonality in Blood Banking Automation, Redlands, California, USA.
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13
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Hubbard JA, Geno KA, Khan J, Szczepiorkowski ZM, de Gijsel D, Ovalle AA, AlSalman AS, Gallagher TL, Johnston AA, Tibbetts AR, Vital SE, Cervinski MA, Nerenz RD. Comparison of Two Automated Immunoassays for the Detection of SARS-CoV-2 Nucleocapsid Antibodies. J Appl Lab Med 2021; 6:429-440. [PMID: 32976593 PMCID: PMC7543392 DOI: 10.1093/jalm/jfaa175] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/14/2020] [Indexed: 02/06/2023]
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel member of the coronavirus family that caused the global coronavirus 2019 (COVID-19) pandemic. The prevalence remains largely unknown because of early testing supply shortages. Although it cannot currently be used to determine level of immunity, antibody testing can contribute to epidemiological studies, identify convalescent plasma donors, or satisfy curiosity about previous exposure to the virus. Methods 407 samples collected from hospitalized inpatients with and without a confirmed SARS-CoV-2 infection, 170 remnant clinical specimens collected and frozen prior to the COVID-19 outbreak, and paired serum and plasma samples from 23 convalescent plasma donors were used to determine performance characteristics of the Abbott SARS-CoV-2 IgG and Roche Elecsys Anti-SARS-CoV-2 assays. The sensitivity, specificity, imprecision, interferences, and sample stability were determined. These assays were then used to characterize the antibody response in serial samples from 20 SARS-CoV-2 positive inpatients. Results Both assays exhibited 100% specificity (95% CI; 99.05 – 100.00), giving no positive results in 170 specimens collected before July 2019 and 215 specimens from patients without a confirmed SARS-CoV-2 infection. Differences between platforms were most notable in SARS-CoV-2 positive samples. Roche offered higher sensitivity in convalescent plasma donors at 95.7% (95% CI; 78.1 – 99.9) versus 91.3% (95% CI; 72.0 – 98.9) but Abbott detected antibodies in two immunocompromised patients whereas Roche did not. The Roche and Abbott platforms also exhibited different trends in antibody signal for a subset of patients. Conclusions Both the Abbott and Roche platforms offer excellent specificity but different trends in antibody signal may reflect qualitative differences in the types of antibodies recognized by the two assays. Negative serologic results do not exclude previous SARS-CoV-2 infection.
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Affiliation(s)
- Jacqueline A Hubbard
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Health System, Lebanon, NH.,The Geisel School of Medicine at Dartmouth, Hanover, NH
| | - K Aaron Geno
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Health System, Lebanon, NH.,The Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Jenna Khan
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Health System, Lebanon, NH
| | - Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Health System, Lebanon, NH.,The Geisel School of Medicine at Dartmouth, Hanover, NH.,Department of Medicine, Dartmouth-Hitchcock Health System, Lebanon, NH
| | - David de Gijsel
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Health System, Lebanon, NH.,Section of Infectious Diseases and International Health, Dartmouth-Hitchcock Health System, Lebanon, NH
| | - Anais A Ovalle
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Health System, Lebanon, NH.,Section of Infectious Diseases and International Health, Dartmouth-Hitchcock Health System, Lebanon, NH
| | - Ahmad S AlSalman
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Health System, Lebanon, NH.,Section of Infectious Diseases and International Health, Dartmouth-Hitchcock Health System, Lebanon, NH
| | - Torrey L Gallagher
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Health System, Lebanon, NH.,The Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Abigail A Johnston
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Health System, Lebanon, NH.,The Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Amanda R Tibbetts
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Health System, Lebanon, NH.,The Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Sarah E Vital
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Health System, Lebanon, NH.,The Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Mark A Cervinski
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Health System, Lebanon, NH.,The Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Robert D Nerenz
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Health System, Lebanon, NH.,The Geisel School of Medicine at Dartmouth, Hanover, NH
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14
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Boada M, López OL, Olazarán J, Núñez L, Pfeffer M, Paricio M, Lorites J, Piñol-Ripoll G, Gámez JE, Anaya F, Kiprov D, Lima J, Grifols C, Torres M, Costa M, Bozzo J, Szczepiorkowski ZM, Hendrix S, Páez A. A randomized, controlled clinical trial of plasma exchange with albumin replacement for Alzheimer's disease: Primary results of the AMBAR Study. Alzheimers Dement 2020; 16:1412-1425. [PMID: 32715623 PMCID: PMC7984263 DOI: 10.1002/alz.12137] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [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: 03/23/2020] [Revised: 05/20/2020] [Accepted: 06/04/2020] [Indexed: 12/19/2022]
Abstract
Introduction This phase 2b/3 trial examined the effects of plasma exchange (PE) in patients with mild‐to‐moderate Alzheimer's disease (AD). Methods Three hundred forty‐seven patients (496 screened) were randomized (1:1:1:1) into three PE treatment arms with different doses of albumin and intravenous immunoglobulin replacement (6‐week period of weekly conventional PE followed by a 12‐month period of monthly low‐volume PE), and placebo (sham). Results PE‐treated patients performed significantly better than placebo for the co‐primary endpoints: change from baseline of Alzheimer's Disease Cooperative Study–Activities of Daily Living (ADCS‐ADL; P = .03; 52% less decline) with a trend for Alzheimer's Disease Assessment Scale–Cognitive Subscale (ADAS‐Cog; P = .06; 66% less decline) scores at month 14. Moderate‐AD patients (baseline Mini‐Mental State Examination [MMSE] 18‐21) scored better on ADCS‐ADL (P = .002) and ADAS‐Cog (P = .05), 61% less decline both. There were no changes in mild‐AD patients (MMSE 22‐26). PE‐treated patients scored better on the Clinical Dementia Rating Sum of Boxes (CDR‐sb) (P = .002; 71% less decline) and Alzheimer's Disease Cooperative Study‐Clinical Global Impression of Change (ADCS‐CGIC) (P < .0001; 100% less decline) scales. Discussion This trial suggests that PE with albumin replacement could slow cognitive and functional decline in AD, although further studies are warranted.
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Affiliation(s)
- Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades - Universitat Internacional de Catalunya, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), Instituto de Salud Carlos III, Madrid, Spain
| | - Oscar L López
- Departments of Neurology and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Javier Olazarán
- Neurology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain.,Memory Disorders Unit - HM Hospitals, Madrid, Spain
| | - Laura Núñez
- Alzheimer's Research Group, Grifols, Barcelona, Spain
| | - Michael Pfeffer
- Medical Services, Allied Biomedical Research Institute, Inc., Miami, Florida, USA
| | - María Paricio
- Center for Prevention of Alzheimer´s Disease, Miami Dade Medical Research Institute, Miami, Florida, USA
| | - Jesús Lorites
- Medical Services, L&L Research Choices, Inc., Miami, Florida, USA
| | - Gerard Piñol-Ripoll
- Seizure Disorders Unit, Clinical Neuroscience Research, IRBLleida-Hospital Universitari Santa Maria, Lleida, Spain
| | - José E Gámez
- Psychiatry Department, Galiz Research, Hialeah, Florida, USA
| | - Fernando Anaya
- Nephrology Service, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Dobri Kiprov
- Apheresis Care Group and Fresenius Medical Care, San Francisco, California, USA
| | - José Lima
- American Red Cross Southern Blood Services Region, Atlanta, Georgia, USA
| | | | - Mireia Torres
- Alzheimer's Research Group, Grifols, Barcelona, Spain
| | | | - Jordi Bozzo
- Alzheimer's Research Group, Grifols, Barcelona, Spain
| | - Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | | | - Antonio Páez
- Alzheimer's Research Group, Grifols, Barcelona, Spain
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15
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Szczepiorkowski ZM. Indications for therapeutic apheresis in hematological disorders. Semin Hematol 2020; 57:57-64. [PMID: 32892844 DOI: 10.1053/j.seminhematol.2020.07.008] [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] [Indexed: 11/11/2022]
Abstract
The early apheresis devices were developed in 1930s, but therapeutic apheresis only became widely used decades later, when automated cell separators were introduced. Progress in technical development of these devices continues to this day. Initial use of therapeutic apheresis has not been evidence based. Documents such as the Guidelines by the American Society for Apheresis provided hematologist with better tools to assess the role of therapeutic apheresis in daily practice. This review focuses on the use of therapeutic apheresis in patients with hematological disorders. Four separate apheresis modalities most encountered by hematologists are discussed: therapeutic plasma exchange, therapeutic leukocytapheresis, red blood cell exchange, and extracorporeal photopheresis. Examples of indications are provided and discussed. The future of therapeutic apheresis and its role in different diseases is undergoing continuous re-evaluation as disease pathogenesis is better understood and new treatment options become available.
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Affiliation(s)
- Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA; Institute of Hematology and Transfusion Medicine, Warsaw, Poland.
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16
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Thibodeaux SR, McKenna DH, Szczepiorkowski ZM, Fontaine MJ, Kelley L, Reems JA, Young PP. A multicenter evaluation of heterogeneity in cellular therapy processing laboratory procedure times to assess workload capacity. Transfusion 2020; 60:1811-1820. [PMID: 32654200 DOI: 10.1111/trf.15899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 04/27/2020] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Growth in size and complexity of clinical hematopoietic progenitor cell (HPC) transplant programs necessitates parallel increases in cellular therapy laboratory (CTL) workload. Typically individually developed, HPC product processing is labor and time intensive. Variation in procedure type and numbers across CTLs complicates direct comparisons, and benchmark data are not readily available. STUDY DESIGN AND METHODS Studies were undertaken at seven CTLs. Transplant volume and staff numbers were determined. Staff recorded time performing tasks broken down into steps: paperwork, product acceptance, transport/infusion, processing, and cryopreservation. Times were added to obtain total times for 15 common CTL procedures. RESULTS Annual transplant volume ranged from 53.4 to 463.2, with products processed by a range of 2 to 10 dedicated CTL staff. Paperwork time constituted 23.7% to 62.3% total time; product processing time accounted for 1.8 (for National Marrow Donor Program product receipt) to 62.6% (for red blood cell reduction of allogeneic HPC products from bone marrow) of total processing time. Mean time for 15 procedures ranged from 1.27 to 8.28 hours (standard deviation range, 0.35-2.71 hr). Mean time for products from bone marrow versus peripheral blood was 6.6 ± 2.0 versus 5.5 ± 1.1 hours (p = 0.02). Cryopreservation (6.5 ± 1.6 vs. 4.4 ± 0.85 hr; p < 0.01) and manipulation (6.4 ± 1.5 vs. 4.4 ± 0.85 hr; p < 0.01) added time. CONCLUSION CTL procedures are time intensive, with wide intra- and inter-CTL variation. Paperwork accounted for substantial portion of total time across procedures. Bone marrow source, cryopreservation, and manipulation contributed to longer times. These findings provide concrete data on which to build regarding CTL workload capacity.
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Affiliation(s)
- Suzanne R Thibodeaux
- Division of Laboratory and Genomic Medicine, Department of Pathology and Immunology, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - David H McKenna
- Molecular & Cellular Therapeutics and Department of Laboratory Medicine & Pathology, Division of Transfusion Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.,Institute of Hematology and Transfusion Medicine, Warsaw, Poland, USA
| | - Magali J Fontaine
- Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Linda Kelley
- Cell Therapy Facility, Department of Immunology, Moffitt Cancer Center, Tampa, Florida, USA
| | - Jo-Anna Reems
- Department of Medicine, Division of Hematology and Hematologic Malignancies, University of Utah, Salt Lake, Utah, USA
| | - Pampee P Young
- American Red Cross, Biomedical Services Headquarters, Washington, DC, USA.,Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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17
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Fontaine MJ, Selogie E, Stroncek D, McKenna D, Szczepiorkowski ZM, Takanashi M, Garritsen H, Girdlestone J, Reems JA. Variations in novel cellular therapy products manufacturing. Cytotherapy 2020; 22:337-342. [PMID: 32223996 DOI: 10.1016/j.jcyt.2020.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/10/2020] [Revised: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND AIMS At the frontier of transfusion medicine and transplantation, the field of cellular therapy is emerging. Most novel cellular therapy products are produced under investigational protocols with no clear standardization across cell processing centers. Thus, the purpose of this study was to uncover any variations in manufacturing practices for similar cellular therapy products across different cell processing laboratories worldwide. METHODS An exploratory survey that was designed to identify variations in manufacturing practices in novel cellular therapy products was sent to cell processing laboratory directors worldwide. The questionnaire focused on the manufacturing life cycle of different cell therapies (i.e., collection, purification, in vitro expansion, freezing and storage, and thawing and washing), as well as the level of regulations followed to process each product type. RESULTS The majority of the centers processed hematopoietic progenitor cells (HPCs) from peripheral blood (n = 18), bone marrow (n = 16) or cord blood (n = 19), making HPCs the most commonly processed cells. The next most commonly produced cellular therapies were lymphocytes (n = 19) followed by mesenchymal stromal cells (n = 14), dendritic cells (n = 9) and natural killer (NK) cells (n = 9). A minority of centers (<5) processed pancreatic islet cells (n = 4), neural cells (n = 3) and induced-pluripotent stem cells (n = 3). Thirty-two laboratories processed products under an investigational status, for either phase I/II (n = 27) or phase III (n = 17) clinical trials. If purification methods were used, these varied for the type of product processed and by institution. Environmental monitoring methods also varied by product type and institution. CONCLUSION This exploratory survey shows a wide variation in cellular therapy manufacturing practices across different cell processing laboratories. A better understanding of the effect of these variations on the quality of these cell-based therapies will be important to assess for further process evaluation and development.
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Affiliation(s)
- Magali J Fontaine
- University of Maryland School of Medicine, Baltimore, Maryland, USA; Biomedical Excellence for Safer Transfusion (BEST).
| | | | - David Stroncek
- Biomedical Excellence for Safer Transfusion (BEST); Center for Cellular Engineering, Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
| | - David McKenna
- Biomedical Excellence for Safer Transfusion (BEST); Molecular and Cellular Therapeutics, University of Minnesota, Saint Paul, Minnesota, USA
| | - Zbigniew M Szczepiorkowski
- Biomedical Excellence for Safer Transfusion (BEST); Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - Minoko Takanashi
- Biomedical Excellence for Safer Transfusion (BEST); Japanese Red Cross Society Blood Service Headquarters, Tokyo, Japan
| | - Henk Garritsen
- Biomedical Excellence for Safer Transfusion (BEST); Institut für Klinische Transfusionsmedizin, Städtisches Klinikum Braunschweig gGmbH, Braunschweig, Germany
| | - John Girdlestone
- Biomedical Excellence for Safer Transfusion (BEST); NHS Blood and Transplant, The John Radcliffe Hospital, Oxford, UK
| | - Jo-Anna Reems
- Biomedical Excellence for Safer Transfusion (BEST); University of Utah, Salt Lake City, Utah, USA
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18
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Annen K, Zubair A, Schwartz E, Schwartz J, Szczepiorkowski ZM. What's in Your CART? Clinical insights on challenges in mononuclear cell collection for CAR-T therapy. J Clin Apher 2020; 35:234-235. [PMID: 32186782 DOI: 10.1002/jca.21776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 02/17/2020] [Accepted: 02/28/2020] [Indexed: 12/25/2022]
Affiliation(s)
- Kyle Annen
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Abba Zubair
- Laboratory Medicine and Pathology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Eileen Schwartz
- Therapeutic Apheresis, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Joseph Schwartz
- Cell Biology, Columbia University Medical Center & the New York Presbyterian Hospital, New York, New York, USA
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19
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Boada M, López O, Núñez L, Szczepiorkowski ZM, Torres M, Grifols C, Páez A. Plasma exchange for Alzheimer's disease Management by Albumin Replacement (AMBAR) trial: Study design and progress. Alzheimers Dement (N Y) 2019; 5:61-69. [PMID: 30859122 PMCID: PMC6395854 DOI: 10.1016/j.trci.2019.01.001] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Introduction Preliminary studies have shown that treatment with plasma exchange (PE) plus therapeutic albumin replacement in patients with Alzheimer's disease (AD) induced mobilization of plasma and cerebrospinal fluid amyloid β protein, associated with an improvement in memory and language functions, as well as the stabilization of brain perfusion, which persisted after treatment discontinuation. Methods Alzheimer's Management By Albumin Replacement (AMBAR) is a multicenter, randomized, blinded and placebo-controlled, parallel-group, phase IIb/III trial enrolling patients with mild to moderate AD. The study evaluates PE with different replacement volumes of therapeutic albumin (5% and 20% Albutein®, Grifols), with or without intravenous immunoglobulin (Flebogamma® 5% DIF, Grifols). Patients are randomized to one of three active treatment groups or one control (sham PE) group (1:1:1:1). The intervention regime includes a first 6-week stage of intensive treatment, followed by a second 12-month stage of maintenance treatment. The change from the baseline to the end of treatment periods in the ADAS-Cog and ADCS-ADL scores are the coprimary efficacy variables. Secondary efficacy variables include change from the baseline in scores on cognitive, functional, behavioral, and overall progression tests; changes in plasma and cerebrospinal fluid levels of amyloid β and tau protein; and assessment of structural and functional changes in brain areas of interest. Safety and tolerability are assessed. Results The study has enrolled 496 patients from 41 centers (19 in Spain and 22 in the USA); 347 of these patients were randomized and underwent close to 5000 PEs, of which approximately 25% were sham PEs. Discussion We present an innovative approach for treating AD. The study has been designed to demonstrate clinical efficacy, defined as slow decline of the patient's cognition and brain function. The sample size has adequate power to detect differences between any of the active treatment groups and the control group, as well as between the three active treatment groups combined and the control group. AMBAR approaches Alzheimer's disease with plasma exchange plus albumin replacement. Clinical efficacy is to slow decline of the patient's cognition and brain function. Sample size has power to detect differences between treatments and controls. Interim results showed a safety profile similar to other plasma exchange indications.
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Affiliation(s)
- Mercè Boada
- Research Center and Memory Clinic, Fundació ACE, Institut Català de Neurociències Aplicades, Barcelona, Spain.,Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Oscar López
- Departments of Neurology and Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Laura Núñez
- Bioscience Research Group. Grifols S.A., Barcelona, Spain
| | | | - Mireia Torres
- Bioscience Research Group. Grifols S.A., Barcelona, Spain
| | | | - Antonio Páez
- Bioscience Research Group. Grifols S.A., Barcelona, Spain
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20
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Takanashi M, Selogie E, Reems JA, Stroncek D, Fontaine MJ, Girdlestone J, Garritsen HSP, Young P, McKenna DH, Szczepiorkowski ZM. Current practices for viability testing of cryopreserved cord blood products: an international survey by the cellular therapy team of the Biomedical Excellence for Safer Transfusion (BEST) Collaborative. Transfusion 2019; 58:2184-2191. [PMID: 30204955 DOI: 10.1111/trf.14777] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Viability testing is a common practice in laboratories. The goal of this study was to ascertain current laboratory practices internationally for performing viability testing for cryopreserved cord blood (CB) products and glean information about how to standardize the method to improve interlaboratory reproducibility. STUDY DESIGN AND METHODS A survey to evaluate current laboratory practices for viability testing was designed and distributed internationally. The question topics included sampling and testing methods, responses to unexpected results, and the rating of the reliability of the CB quality tests, together with expectations for standardization. RESULTS There were 32 respondents to the survey, of whom 28 responded to the more detailed questionnaire about viability methods. Overall, responses indicated that various stains were used among the laboratories, and when multiple sites used the same viability stain the methods differed. The majority of the respondents were in favor of standardizing the viability testing methods. A wide variety of preferences were communicated about how to standardize the method, but a majority did advocate the use of 7-aminoactinomycin D (7-AAD) with flow cytometry. CONCLUSIONS The survey results revealed a variety of tests and inconsistent interlaboratory practices for performing the viability assay. Flow cytometry with a 7-AAD dye was suggested as a first step toward standardization.
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Affiliation(s)
- Minoko Takanashi
- Japanese Red Cross Society Blood Service Headquarters, Tokyo, Japan.,Biomedical Excellence for Safer Transfusion (BEST) Collaborative, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Eileen Selogie
- Biomedical Excellence for Safer Transfusion (BEST) Collaborative, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Jo-Anna Reems
- Biomedical Excellence for Safer Transfusion (BEST) Collaborative, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,University of Utah, Salt Lake City, Utah
| | - David Stroncek
- Biomedical Excellence for Safer Transfusion (BEST) Collaborative, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Transfusion Medicine, Clinical Center, National Institutes of Health, Bethesda, Maryland
| | - Magali J Fontaine
- Biomedical Excellence for Safer Transfusion (BEST) Collaborative, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Transfusion Services, Department of Pathology, University of Maryland School of Medicine, Baltimore, Maryland
| | - John Girdlestone
- Biomedical Excellence for Safer Transfusion (BEST) Collaborative, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Stem Cells and Immunotherapies, NHS Blood and Transplant, The John Radcliffe Hospital, Oxford, UK
| | - Henk S P Garritsen
- Biomedical Excellence for Safer Transfusion (BEST) Collaborative, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Institute for Clinical Transfusion Medicine, Municipal Hospital Braunschweig gGmbH.,Fraunhofer Institute for Surface Engineering and Thin Film IST, Braunschweig, Germany
| | - Pampee Young
- Biomedical Excellence for Safer Transfusion (BEST) Collaborative, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Vanderbilt University, Nashville, Tennessee
| | - David H McKenna
- Biomedical Excellence for Safer Transfusion (BEST) Collaborative, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Molecular & Cellular Therapeutics, University of Minnesota, Saint Paul, Minnesota
| | - Zbigniew M Szczepiorkowski
- Biomedical Excellence for Safer Transfusion (BEST) Collaborative, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Institute of Hematology and Transfusion Medicine, Warsaw, Poland
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21
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Slichter SJ, Dumont LJ, Cancelas JA, Jones M, Gernsheimer TB, Szczepiorkowski ZM, Dunbar NM, Prakash G, Medlin S, Rugg N, Kinne B, Macdonald VW, Housler G, Valiyaveettil M, Hmel P, Ransom JH. Safety and efficacy of cryopreserved platelets in bleeding patients with thrombocytopenia. Transfusion 2018; 58:2129-2138. [DOI: 10.1111/trf.14780] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 03/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Sherrill J. Slichter
- Research Institute, Bloodworks Northwest; Seattle Washington
- University of Washington School of Medicine; Seattle Washington
| | - Larry J. Dumont
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
- Blood Systems Research Institute; Denver Colorado
| | - Jose A. Cancelas
- Hoxworth Blood Center; University of Cincinnati; Cincinnati Ohio
| | - MeLinh Jones
- Research Institute, Bloodworks Northwest; Seattle Washington
| | | | | | - Nancy M. Dunbar
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Gautham Prakash
- Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Stephen Medlin
- University of Cincinnati Health Hospital; Cincinnati Ohio
| | - Neeta Rugg
- Hoxworth Blood Center; University of Cincinnati; Cincinnati Ohio
| | - Bridget Kinne
- University of Cincinnati Health Hospital; Cincinnati Ohio
| | | | - Greggory Housler
- U.S. Army Medical Research and Materiel Command; Fort Detrick Maryland
| | | | - Peter Hmel
- Fast-Track Drugs & Biologics, LLC; North Potomac Maryland
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22
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Ward SJ, Stramer SL, Szczepiorkowski ZM. Assessing the risk of Babesia
to the United States blood supply using a risk-based decision-making approach: Report of AABB's Ad Hoc Babesia
Policy Working Group (original report). Transfusion 2018; 58:1916-1923. [DOI: 10.1111/trf.14912] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 07/20/2018] [Accepted: 07/29/2018] [Indexed: 11/30/2022]
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23
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Ruby KN, Thomasson RR, Szczepiorkowski ZM, Dunbar NM. Bacterial screening of apheresis platelets with a rapid test: a 113‐month single center experience. Transfusion 2018; 58:1665-1669. [DOI: 10.1111/trf.14629] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 02/06/2018] [Accepted: 02/15/2018] [Indexed: 11/26/2022]
Affiliation(s)
- Kristen N. Ruby
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
| | - Reggie R. Thomasson
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
| | - Zbigniew M. Szczepiorkowski
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
- Department of MedicineDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
- Geisel School of Medicine at DartmouthHanover New Hampshire
- Institute of Hematology and Transfusion MedicineWarsaw Poland
| | - Nancy M. Dunbar
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
- Department of MedicineDartmouth‐Hitchcock Medical CenterLebanonNew Hampshire
- Geisel School of Medicine at DartmouthHanover New Hampshire
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24
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Coker SA, Szczepiorkowski ZM, Siegel AH, Ferrari A, Mambrini G, Anand R, Hartman RD, Benatti L, Dumont LJ. A Study of the Pharmacokinetic Properties and the In Vivo Kinetics of Erythrocytes Loaded With Dexamethasone Sodium Phosphate in Healthy Volunteers. Transfus Med Rev 2018. [PMID: 29031409 DOI: 10.1016/j.tmry.2017.09.001] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
The objectives of this 2-phase study were to elucidate pharmacokinetics (PK), in vivo 24-hour recovery, and red blood cell (RBC) survival properties of RBC-encapsulated dexamethasone sodium phosphate (DSP) prepared using the EryDex System (EDS). The 24-hour RBC recovery and T50 survival phase studied subjects were randomized to receive autologous RBCs loaded with either 15-20 mg DSP (Group 1A) or sham saline (Group 2A). Loaded RBCs were radiolabeled with 51-Cr, and the labeled RBCs were followed over time in vivo. The PK phase evaluated dose levels of 2.5-5 mg (Group 1B) and 15-20 mg (Group 2B) DSP encapsulated in RBCs infused into healthy randomized subjects. The mean ± SD 24-hour RBC recovery was 77.9% ± 3.3% and 72.7% ± 10.5% for Groups 1A and 2A, respectively. The mean ± SD RBC life span was 84.3 ± 8.3 days in Group 1A and 88.9 ± 6.2 days in Group 2A. The PK phase actual DSP loading doses (mean ± SEM) were 4.2 ± 0.27 mg and 16.9 ± 0.90 mg in Groups 1B and 2B, respectively. Release of dexamethasone from RBCs in vivo peaked at 1 hour, and a sustained release of dexamethasone could be detected until 35 days after the single intravenous infusion in Group 2B. The mean RBC in vivo recovery for DSP-loaded processed cells compares similarly to the 24-hour recovery of regulated RBC products intended for transfusion. There was a minimal but acceptable adverse impact on the survival of EDS-processed RBCs. DSP-loaded autologous RBCs, prepared using the EDS, delivered a sustained dose of dexamethasone in vivo.
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Affiliation(s)
- Shodeinde A Coker
- Section of Hematology and Oncology and The Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Zbigniew M Szczepiorkowski
- Department of Pathology, The Geisel School of Medicine at Dartmouth and The Dartmouth-Hitchcock Medical Center, Lebanon, NH; Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Alan H Siegel
- Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | | | | | | | | | - Larry J Dumont
- Department of Pathology, The Geisel School of Medicine at Dartmouth and The Dartmouth-Hitchcock Medical Center, Lebanon, NH.
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25
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Coker SA, Szczepiorkowski ZM, Siegel AH, Ferrari A, Mambrini G, Anand R, Hartman RD, Benatti L, Dumont LJ. A Study of the Pharmacokinetic Properties and the In Vivo Kinetics of Erythrocytes Loaded With Dexamethasone Sodium Phosphate in Healthy Volunteers. Transfus Med Rev 2018; 32:102-110. [DOI: 10.1016/j.tmrv.2017.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 07/24/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
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26
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Szczepiorkowski ZM, Burnett CA, Dumont LJ, Abhyankar SH. Apheresis buffy coat collection without photoactivation has no effect on apoptosis, cell proliferation, and total viability of mononuclear cells collected using photopheresis systems. Transfusion 2018; 58:943-950. [PMID: 29451308 DOI: 10.1111/trf.14532] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/13/2017] [Accepted: 11/21/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND Extracorporeal photopheresis (ECP) has been approved for the treatment of advanced cutaneous T-cell lymphoma since 1988. While the precise mechanisms resulting in clinical effects are not fully understood, the photoactivation of mononuclear cells (MNCs) using ultraviolet A (UVA) light and methoxsalen is believed to be the predominant initiating process. The effects of MNC passage through the instrument without photoactivation are unknown. The objective of this study was to evaluate the effect of cell processing through the photopheresis instruments on MNCs. STUDY DESIGN AND METHODS Fourteen healthy male subjects underwent one simulated ECP procedure without reinfusion of buffy coats (BCs) in a two-center, open-label, prospective trial. Baseline peripheral blood BC, apheresis-separated untreated BC (BC1), and photoactivated BC (BC2) were evaluated in culture for viability by dye exclusion, apoptosis by annexin V binding, and cell proliferation response to phytohemagglutinin (PHA) stimulation by bromodeoxyuridine (BrdU) incorporation. RESULTS Photoactivation (BC2) resulted in 88% expression of annexin V by Day 1 of culture compared with 37 and 39% for baseline and untreated BC1. Cell viability by propidium iodide exclusion was reduced to 10% in BC2 on Day 1 versus 65 and 60% for baseline and BC1. The proliferative response to PHA stimulation was 97% inhibited in the photoactivated BC2. CONCLUSIONS These results demonstrate that the mechanical processes used for cell separation and processing of the BC in the absence of photoactivation do not induce a significant amount of apoptosis compared to the standard ECP with methoxsalen and UVA photoactivation.
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Affiliation(s)
- Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine.,Department of Medicine, Dartmouth-Hitchcock, Lebanon, New Hampshire.,Dartmouth Geisel School of Medicine, Hanover, New Hampshire.,Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | | | - Larry J Dumont
- Department of Pathology and Laboratory Medicine.,Dartmouth Geisel School of Medicine, Hanover, New Hampshire
| | - Sunil H Abhyankar
- Bone Marrow Transplant Program, University of Kansas Medical Center, Kansas City, Kansas
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27
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Harm SK, Szczepiorkowski ZM, Dunbar NM. Routine use of Day 6 and Day 7 platelets with rapid testing: two hospitals assess impact 1 year after implementation. Transfusion 2018; 58:938-942. [DOI: 10.1111/trf.14473] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Sarah K. Harm
- Department of Pathology and Laboratory Medicine; University of Vermont Medical Center; Burlington Vermont
| | - Zbigniew M. Szczepiorkowski
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
- Institute of Hematology and Transfusion Medicine; Warsaw Poland
| | - Nancy M. Dunbar
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
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28
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Maloney N, Martin I, Szczepiorkowski ZM, Dunbar NM. Therapeutic plasma exchange for thrombotic thrombocytopenic purpura with refractory thrombocytopenia. J Clin Apher 2017; 33:436-438. [PMID: 29270999 DOI: 10.1002/jca.21612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 10/02/2017] [Revised: 11/16/2017] [Accepted: 12/05/2017] [Indexed: 11/06/2022]
Abstract
Thrombotic thrombocytopenic purpura (TTP) is an acute, life-threatening illness with disseminated platelet-rich thromboses of small vessels that variably presents with the classic clinical "pentad" of microangiopathic hemolytic anemia, thrombocytopenia, fever, altered mental status, and acute kidney injury. Most cases are caused by an acquired autoantibody to ADAMTS13, a metalloproteinase that cleaves large von Willebrand Factor (vWF) multimers. The mainstay of treatment is daily therapeutic plasma exchange (TPE), sometimes with adjunctive pharmacologic immunosuppression. TPE is generally continued until the platelet count is greater than 150 × 103 /µL and the lactate dehydrogenase is near normal for 2-3 consecutive days. Unfortunately, there is no clear guidance for when thrombocytopenia is refractory for a prolonged period of time. The following case describes such a scenario in which consecutive ADAMTS13 activity and inhibitor levels were used to guide the decision to stop treatment with TPE in a patient who failed to recover their platelet count.
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Affiliation(s)
- Nolan Maloney
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Isabella Martin
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Medicine, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
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29
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Gniadek TJ, Garritsen HS, Stroncek D, Szczepiorkowski ZM, McKenna DH. Optimal Storage Conditions for Apheresis Research (OSCAR): a Biomedical Excellence for Safer Transfusion (BEST) Collaborative study. Transfusion 2017; 58:461-469. [DOI: 10.1111/trf.14429] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/27/2017] [Accepted: 10/05/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Thomas J. Gniadek
- Molecular & Cellular Therapeutics; University of Minnesota; Saint Paul Minnesota
| | - Henk S.P. Garritsen
- Institute for Clinical Transfusion Medicine, Municipal Hospital Braunschweig gGmbH; Braunschweig Germany
- Fraunhofer Institute for Surface Engineering and Thin Film IST; Braunschweig Germany
| | - David Stroncek
- Department of Transfusion Medicine, Clinical Center; National Institutes of Health; Bethesda Maryland
| | - Zbigniew M. Szczepiorkowski
- Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
- Institute for Hematology and Transfusion Medicine; Warsaw Poland
| | - David H. McKenna
- Molecular & Cellular Therapeutics; University of Minnesota; Saint Paul Minnesota
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30
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Yerrabothala S, Talebian L, Klinker K, Hickman J, Hill JM, Hayes C, Lowrey C, Szczepiorkowski ZM, Meehan KR. Extracorporeal photopheresis for graft versus host disease: Identifying a clinical pathway and associated resource utilization. J Clin Apher 2017; 33:310-315. [PMID: 29193271 DOI: 10.1002/jca.21606] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/16/2017] [Revised: 10/09/2017] [Accepted: 11/06/2017] [Indexed: 01/25/2023]
Abstract
Extracorporeal photopheresis (ECP) is an established therapy for the treatment of graft-versus-host-disease (GVHD) following an allogeneic stem cell transplant. We performed a prospective analysis of patients receiving ECP treatment for GVHD to identify a clinical pathway and resource utilization of this process. The cohort included consecutive allogeneic stem cell recipients with GVHD. ECP was performed using the CELLEX Photopheresis System or the UVAR XTS Photopheresis System (Therakos, Inc, Exton, PA). A clinical pathway was developed and a time and motion study was conducted to define the resource utilization and costs associated with ECP. Patients were treated with either CELLEX (n = 18 procedures) or UVAR (n = 4 procedures). Total time commitment for each procedure for the 2 machines differed. The time for ECP was 117 min (median, range: 91-164 min) using CELLEX and 161 min (median; range: 140-210) using the UVAR-XTS machine. Total costs of each ECP procedure were $3420.50. There is a considerable time commitment of the patient and the clinical staff when employing ECP to treat GVHD. ECP costs are significant considering this is a prolonged therapy continued for several months. With this finalized pathway and costs, we have a standardized clinical pathway for the treatment of GVHD. We are addressing minimizing resource utilization while emphasizing quality care for these patients.
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Affiliation(s)
- Swaroopa Yerrabothala
- Division of Hematology and Oncology and the, The Blood and Marrow Transplant Program, Lebanon, New Hampshire 03756.,Cellular Therapy Center and Blood Bank/Transfusion Medicine Service, Dartmouth Hitchcock Medical Center, Dartmouth Medical School, and the Norris Cotton Cancer Center, Lebanon, New Hampshire 03756
| | - Laleh Talebian
- Division of Hematology and Oncology and the, The Blood and Marrow Transplant Program, Lebanon, New Hampshire 03756
| | - Karen Klinker
- Division of Hematology and Oncology and the, The Blood and Marrow Transplant Program, Lebanon, New Hampshire 03756.,Cellular Therapy Center and Blood Bank/Transfusion Medicine Service, Dartmouth Hitchcock Medical Center, Dartmouth Medical School, and the Norris Cotton Cancer Center, Lebanon, New Hampshire 03756
| | - Joshua Hickman
- Division of Hematology and Oncology and the, The Blood and Marrow Transplant Program, Lebanon, New Hampshire 03756
| | - John M Hill
- Division of Hematology and Oncology and the, The Blood and Marrow Transplant Program, Lebanon, New Hampshire 03756
| | - Christi Hayes
- Division of Hematology and Oncology and the, The Blood and Marrow Transplant Program, Lebanon, New Hampshire 03756
| | - Christopher Lowrey
- Division of Hematology and Oncology and the, The Blood and Marrow Transplant Program, Lebanon, New Hampshire 03756
| | - Zbigniew M Szczepiorkowski
- Cellular Therapy Center and Blood Bank/Transfusion Medicine Service, Dartmouth Hitchcock Medical Center, Dartmouth Medical School, and the Norris Cotton Cancer Center, Lebanon, New Hampshire 03756.,Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Kenneth R Meehan
- Division of Hematology and Oncology and the, The Blood and Marrow Transplant Program, Lebanon, New Hampshire 03756
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31
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Linnik YA, Tsui EW, Martin IW, Szczepiorkowski ZM, Denomme GA, Gottschall JL, Hill JM, Dunbar NM. The first reported case of concurrent trimethoprim-sulfamethoxazole-induced immune hemolytic anemia and thrombocytopenia. Transfusion 2017; 57:2937-2941. [PMID: 28905389 DOI: 10.1111/trf.14315] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 06/29/2017] [Accepted: 07/01/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Drug-induced immune hemolytic anemia (DIIHA) and drug-induced immune thrombocytopenia (DIIT) are rare but dangerous complications of pharmacotherapy that may be underrecognized in hematopoietic stem cell transplant (HSCT) patients due to overlap of signs and symptoms with those of more common disease processes. CASE REPORT A 61-year-old woman with NK-cell deficiency and GATA-2-associated myelodysplastic syndrome, status post-recent allogeneic HSCT (Day +58), presented with 3 days of acute-onset severe back pain, muscle cramps, and increasingly dark urine. She was found to be anemic, thrombocytopenic, and in acute renal failure. On admission, the direct antiglobulin test was positive for complement (C3) only. After careful review of her medication list, the possibility of DIIHA was raised. She had started taking trimethoprim-sulfamethoxazole (TMP-SMX) for Pneumocystis jiroveci pneumonia prophylaxis 24 days prior on a weekend dose schedule. Serologic tests on peripheral blood samples were performed using standard methods. Drug studies were performed at an immunohematology reference laboratory. RESULTS The patient's serum showed hemolysis of donor red blood cells in the presence of TMP-SMX and also TMP-SMX-induced platelet antibodies. The patient was treated with transfusions, hemodialysis, and immunosuppressive agents. Her clinical condition improved and she was discharged after 8 days in stable condition. CONCLUSION This case describes the first reported concurrent DIIHA and DIIT due to TMP-SMX-induced antibodies in an HSCT patient. DIIHA and DIIT can present a diagnostic challenge in the setting of intermittent medication dosing.
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Affiliation(s)
- Yevgeniy A Linnik
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Edison W Tsui
- Department of Internal Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Isabella W Martin
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Gregory A Denomme
- Diagnostic Laboratories and Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin
| | - Jerome L Gottschall
- Diagnostic Laboratories and Blood Research Institute, BloodCenter of Wisconsin, Milwaukee, Wisconsin.,Department of Pathology, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - John M Hill
- Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire.,Blood and Marrow Transplant Program, Norris Cotton Cancer Center, Hanover, New Hampshire
| | - Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Medicine, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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32
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Worsham DN, Reems JA, Szczepiorkowski ZM, McKenna DH, Leemhuis T, Mathew AJ, Cancelas JA. Clinical methods of cryopreservation for donor lymphocyte infusions vary in their ability to preserve functional T-cell subpopulations. Transfusion 2017; 57:1555-1565. [DOI: 10.1111/trf.14112] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/03/2017] [Accepted: 02/07/2017] [Indexed: 12/17/2022]
Affiliation(s)
| | - Jo-Anna Reems
- University of Utah School of Medicine; Salt Lake City Utah
| | | | | | - Thomas Leemhuis
- Hoxworth Blood Center, University of Cincinnati; Cincinnati Ohio
| | | | - Jose A. Cancelas
- Hoxworth Blood Center, University of Cincinnati; Cincinnati Ohio
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33
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D'Alessandro A, Gray AD, Szczepiorkowski ZM, Hansen K, Herschel LH, Dumont LJ. Red blood cell metabolic responses to refrigerated storage, rejuvenation, and frozen storage. Transfusion 2017; 57:1019-1030. [PMID: 28295356 DOI: 10.1111/trf.14034] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 11/10/2016] [Accepted: 12/19/2016] [Indexed: 01/28/2023]
Abstract
BACKGROUND Storage of red blood cells (RBCs) under blood bank conditions promotes metabolic modulation within the RBC. This "metabolic storage lesion" may affect the quality and safety of the transfused RBCs. The aim of this study is to determine the metabolic changes in stored RBCs over 42 days of routine storage followed by a US Food and Drug Administration-approved method of rejuvenation, freezing, and preparation for transfusion. STUDY DESIGN AND METHODS We exploited a mass spectrometry-based metabolomics approach to monitor 42-day-stored citrate phosphate dextrose/AS-1 RBCs (n = 29) that were rejuvenated, glycerolized and frozen, then thawed and deglycerolized, and held for 24 hours at 1 to 6ºC in saline-glucose. RESULTS Previously reported metabolic alterations were confirmed in 42-day-old RBCs. In this study, in total, 181 (62%) of the biochemical compounds exhibited significant (p ≤ 0.05) change compared with Day 0 values. Rejuvenation restored adenosine triphosphate and 2,3-diphosphoglycerate levels, replenished purine reservoirs, up regulated glycolysis, increased levels of pentose phosphate pathway intermediates, and partially rescued glutathione biosynthesis. Increased levels of lysophospholipid in rejuvenated RBCs suggests the activation of recycling pathways of damaged membrane lipids, in which a total of 167 (57%) biochemical compounds showed significant change compared with Day 42 values. CONCLUSION Rejuvenation reversed over one-half of the metabolic biochemical compounds evaluated compared with Day 42 values, and the compounds were stable through frozen storage and preparation for transfusion. Rejuvenation promoted significant metabolic reprogramming, including the reactivation of energy-generating and antioxidant pathways (the pentose phosphate pathway and glutathione homeostasis), salvage reactions, cofactor reservoirs, and membrane lipid recycling.
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Affiliation(s)
- Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | | | - Zbigniew M Szczepiorkowski
- Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Institute of Hematology and Transfusion Medicine, Warsaw, Poland
| | - Kirk Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | | | - Larry J Dumont
- Department of Pathology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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34
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Dunbar NM, Olson NJ, Szczepiorkowski ZM, Martin ED, Tysarcyk RM, Triulzi DJ, Alarcon LH, Yazer MH. Blood component transfusion and wastage rates in the setting of massive transfusion in three regional trauma centers. Transfusion 2016; 57:45-52. [PMID: 27774614 DOI: 10.1111/trf.13880] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 08/29/2016] [Accepted: 08/29/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of massive transfusion protocols (MTPs) is to provide large quantities of blood products rapidly to exsanguinating patients. The expected rates of blood product transfusion and wastage in this setting have not been defined. This study was undertaken to assess the transfusion and wastage rates for bleeding patients requiring emergency issue of blood components at three American Level I trauma centers. STUDY DESIGN AND METHODS Three hospitals participated, all of which are Level I trauma centers that have MTPs in place where uncrossmatched red blood cells (RBCs) can be ordered with or without platelets (PLTs), plasma, and cryoprecipitate. Data on the transfusion, return to blood bank, and wastage rates were recorded on all products issued within 3 hours after MTP activation. RESULTS The majority of products were issued to the emergency department and/or operating room at all three institutions (84%-95%). The percentage of RBCs, plasma, and PLTs transfused during MTPs were 39% to 65%, 43% to 66%, and 75% to 100%, respectively. Wastage rates were comparable for RBCs (0%-9%), plasma (0%-7%), and PLTs (0%-7%). Cryoprecipitate had the highest wastage rates at all three sites (7%-33%). CONCLUSION A large portion of blood products issued during MTPs are not transfused. Some are wasted due to stringent storage requirements and/or limited shelf lives. The optimum ratio of transfused to returned products in these patients is likely to be determined more by clinical need than by transfusion service policy.
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Affiliation(s)
- Nancy M Dunbar
- Department of Pathology and Laboratory Medicine, the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Medicine, and the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Nicholas J Olson
- Department of Pathology and Laboratory Medicine, the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Zbigniew M Szczepiorkowski
- Department of Pathology and Laboratory Medicine, the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.,Department of Medicine, and the Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | - Eric D Martin
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
| | | | - Darrell J Triulzi
- The Institute for Transfusion Medicine.,Department of Pathology, and the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Louis H Alarcon
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Mark H Yazer
- The Institute for Transfusion Medicine.,Department of Pathology, and the University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
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35
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Alquist CR, Szczepiorkowski ZM, Dunbar N. Babesia parasitemia rebound after red blood cell exchange. J Clin Apher 2016; 32:276-278. [DOI: 10.1002/jca.21492] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 06/24/2016] [Accepted: 07/21/2016] [Indexed: 11/08/2022]
Affiliation(s)
- Caroline R. Alquist
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center, Transfusion Medicine Service; Lebanon New Hampshire 03756
| | - Zbigniew M. Szczepiorkowski
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center, Transfusion Medicine Service; Lebanon New Hampshire 03756
- Institute of Hematology and Transfusion Medicine; Warsaw Poland
| | - Nancy Dunbar
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center, Transfusion Medicine Service; Lebanon New Hampshire 03756
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36
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Dunbar NM, Raval JS, Johnson A, Abikoff CM, Adamski J, Cooling LL, Grossman B, Kim HC, Marques MB, Morgan S, Schmidt AE, Sloan SR, Su LL, Szczepiorkowski ZM, West FB, Wong E, Schneiderman J. Extracorporeal photopheresis practice patterns: An international survey by the ASFA ECP subcommittee. J Clin Apher 2016; 32:215-223. [DOI: 10.1002/jca.21486] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 01/02/2023]
Affiliation(s)
- Nancy M. Dunbar
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon NH
| | - Jay S. Raval
- Department of Pathology and Laboratory Medicine; University of North Carolina; Chapel Hill NC
| | - Andrew Johnson
- Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis MN
| | - Cori M. Abikoff
- Department of Pediatrics; New York Medical College; Valhalla NY
| | - Jill Adamski
- Department of Laboratory Medicine and Pathology, Mayo Clinic; Phoenix AZ
| | - Laura L. Cooling
- Department of Pathology, University of Michigan School of Medicine; Ann Arbor MI
| | - Brenda Grossman
- Department of Pathology and Immunology, Washington University School of Medicine in St. Louis; St. Louis MO
| | - Haewon C. Kim
- Department of Pathology and Laboratory Medicine; Children's Hospital of Philadelphia; Philadelphia PA
| | | | - Shanna Morgan
- Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis MN
- American Red Cross; St. Paul MN
- Veterans Affairs Medical Center; Minneapolis MN
| | - Amy E. Schmidt
- Department of Pathology and Laboratory Medicine; University of Rochester Medical Center; Rochester NY
| | - Steven R. Sloan
- Department of Laboratory Medicine; Boston Children's Hospital; Boston MA
| | - Leon L. Su
- Department of Pathology and Laboratory Medicine; Phoenix Children's Hospital; Phoenix AZ
| | - Zbigniew M. Szczepiorkowski
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon NH
- Institute of Hematology and Transfusion Medicine; Warsaw Poland
| | | | - Edward Wong
- Departments of Pediatrics and Pathology, George Washington School of Medicine and Health Sciences, Division of Laboratory Medicine; Children's National Health System; Washington DC
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37
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Raasch Alquist C, Root L, Dunbar N, Szczepiorkowski ZM. Highlighting oft-overlooked granulocyte-colony-stimulating factor kinetics. Transfusion 2016; 56:1484-5. [PMID: 27264014 DOI: 10.1111/trf.13604] [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: 02/11/2016] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 11/28/2022]
Affiliation(s)
| | - Lynn Root
- Department of Medicine, Hematology/Oncology Section, Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | - Nancy Dunbar
- Department of Pathology and Laboratory Medicine, Transfusion Medicine Service, Lebanon, NH
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38
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Szczepiorkowski ZM, McCullough J, Triulzi DJ. Primum non confundere: whole blood versus apheresis platelet debate continues. Transfusion 2016; 56:1254-7. [DOI: 10.1111/trf.13642] [Citation(s) in RCA: 5] [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] [Received: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 11/30/2022]
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39
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Dunbar NM, Dumont LJ, Szczepiorkowski ZM. How do we implement Day 6 and Day 7 platelets at a hospital-based transfusion service? Transfusion 2016; 56:1262-6. [DOI: 10.1111/trf.13577] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 02/11/2016] [Accepted: 02/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Nancy M. Dunbar
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
- Department of Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
- Geisel School of Medicine at Dartmouth; Hanover New Hampshire
| | - Larry J. Dumont
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
- Center for Transfusion Medicine Research; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
- Geisel School of Medicine at Dartmouth; Hanover New Hampshire
| | - Zbigniew M. Szczepiorkowski
- Department of Pathology and Laboratory Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
- Geisel School of Medicine at Dartmouth; Hanover New Hampshire
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40
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Dumont LJ, D'Alessandro A, Szczepiorkowski ZM, Yoshida T. CO2 -dependent metabolic modulation in red blood cells stored under anaerobic conditions. Transfusion 2015; 56:392-403. [PMID: 26477888 DOI: 10.1111/trf.13364] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/27/2015] [Accepted: 08/27/2015] [Indexed: 12/16/2022]
Abstract
BACKGROUND Anaerobic red blood cell (RBC) storage reduces oxidative damage, maintains adenosine triphosphate (ATP) and 2,3-diphosphoglycerate (DPG) levels, and has superior 24-hour recovery at 6 weeks compared to standard storage. This study will determine if removal of CO2 during O2 depletion by gas exchange may affect RBCs during anaerobic storage. STUDY DESIGN AND METHODS This is a matched three-arm study (n = 14): control, O2 and CO2 depleted with Ar (AN), and O2 depleted with 95%Ar/5%CO2 (AN[CO2 ]). RBCs in additives AS-3 or OFAS-3 were evenly divided into three bags, and anaerobic conditions were established by gas exchange. Bags were stored at 1 to 6°C in closed chambers under anaerobic conditions or ambient air, sampled weekly for up to 9 weeks for a panel of in vitro tests. A full metabolomics screening was conducted for the first 4 weeks of storage. RESULTS Purging with Ar (AN) results in alkalization of the RBC and increased glucose consumption. The addition of 5% CO2 to the purging gas prevented CO2 loss with an equivalent starting and final pH and lactate to control bags (p > 0.5, Days 0-21). ATP levels are higher in AN[CO2 ] (p < 0.0001). DPG was maintained beyond 2 weeks in the AN arm (p < 0.0001). Surprisingly, DPG was lost at the same rate in both control and AN[CO2 ] arms (p = 0.6). CONCLUSION Maintenance of ATP in the AN[CO2 ] arm demonstrates that ATP production is not solely a function of the pH effect on glycolysis. CO2 in anaerobic storage prevented the maintenance of DPG, and DPG production appears to be pH dependent. CO2 as well as O2 depletion provides metabolic advantage for stored RBCs.
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Affiliation(s)
- Larry J Dumont
- Pathology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado.,Metabolomics Core, Mass Spectrometry Shared Resource-SOM, University of Colorado Denver, Aurora, Colorado
| | - Zbigniew M Szczepiorkowski
- Pathology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.,Pathology, Dartmouth-Hitchcock, Lebanon, New Hampshire
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41
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Martin IW, Katus MC, Martin CLB, Szczepiorkowski ZM, Gorham JD, Dunbar NM. Rapid ADAMTS13 availability impacts treatment for microangiopathic hemolytic anemia and thrombocytopenia. J Clin Apher 2015; 31:419-22. [DOI: 10.1002/jca.21419] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 07/11/2015] [Accepted: 07/13/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Isabella W. Martin
- Department of Pathology; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | | | | | | | - James D. Gorham
- Department of Pathology; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Nancy M. Dunbar
- Department of Pathology; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
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42
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D'Alessandro A, Nemkov T, Hansen KC, Szczepiorkowski ZM, Dumont LJ. Red blood cell storage in additive solution-7 preserves energy and redox metabolism: a metabolomics approach. Transfusion 2015; 55:2955-66. [PMID: 26271632 DOI: 10.1111/trf.13253] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/05/2015] [Accepted: 06/21/2015] [Indexed: 12/28/2022]
Abstract
BACKGROUND Storage and transfusion of red blood cells (RBCs) has a huge medical and economic impact. Routine storage practices can be ameliorated through the implementation of novel additive solutions (ASs) that tackle the accumulation of biochemical and morphologic lesion during routine cold liquid storage in the blood bank, such as the recently introduced alkaline solution AS-7. Here we hypothesize that AS-7 might exert its beneficial effects through metabolic modulation during routine storage. STUDY DESIGN AND METHODS Apheresis RBCs were resuspended either in control AS-3 or experimental AS-7, before ultrahigh-performance liquid chromatography-mass spectrometry metabolomics analysis. RESULTS Unambiguous assignment and relative quantitation was achieved for 229 metabolites. AS-3 and AS-7 results in many similar metabolic trends over storage, with AS-7 RBCs being more metabolically active in the first storage week. AS-7 units had faster fueling of the pentose phosphate pathway, higher total glutathione pools, and increased flux through glycolysis as indicated by higher levels of pathway intermediates. Metabolite differences are especially observed at 7 days of storage, but were still maintained throughout 42 days. CONCLUSION AS-7 formulation (chloride free and bicarbonate loading) appears to improve energy and redox metabolism in stored RBCs in the early storage period, and the differences, though diminished, are still appreciable by Day 42. Energy metabolism and free fatty acids should be investigated as potentially important determinants for preservation of RBC structure and function. Future studies will be aimed at identifying metabolites that correlate with in vitro and in vivo circulation times.
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Affiliation(s)
- Angelo D'Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | - Travis Nemkov
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | - Kirk C Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado
| | | | - Larry J Dumont
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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43
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Dunbar NM, Szczepiorkowski ZM. How do we utilize a transfusion safety officer? Transfusion 2015; 55:2064-8. [DOI: 10.1111/trf.13184] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Revised: 04/22/2015] [Accepted: 04/22/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Nancy M. Dunbar
- Department of Pathology
- Department of Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
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44
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Martin IW, Martin CLB, Dunbar NM, Lee SL, Szczepiorkowski ZM. Therapeutic plasma exchange as a steroid-sparing therapy in a patient with limbic encephalitis due to antibodies to voltage-gated potassium channels. J Clin Apher 2015; 31:63-5. [DOI: 10.1002/jca.21395] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 02/05/2015] [Accepted: 03/07/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Isabella W. Martin
- Department of Pathology; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | | | - Nancy M. Dunbar
- Department of Pathology; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Stephen L. Lee
- Department of Neurology; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
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45
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Dunbar NM, Katus MC, Freeman CM, Szczepiorkowski ZM. Easier said than done: ABO compatibility and D matching in apheresis platelet transfusions. Transfusion 2015; 55:1882-8. [DOI: 10.1111/trf.13077] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Revised: 02/09/2015] [Accepted: 02/10/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Nancy M. Dunbar
- Department of Pathology
- Department of Medicine; Dartmouth-Hitchcock Medical Center; Lebanon New Hampshire
| | - Matthew C. Katus
- Department of Pathology
- Community Blood Services; Montvale New Jersey
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46
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Weber LL, Dunbar NM, Meehan KR, Szczepiorkowski ZM, Lansigan F. Successful implementation of a rural extracorporeal photopheresis program for the treatment of cutaneous T-cell lymphoma and chronic graft-versus-host disease in a rural hospital. J Clin Apher 2015; 30:359-63. [DOI: 10.1002/jca.21382] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Accepted: 01/06/2015] [Indexed: 11/06/2022]
Affiliation(s)
| | - Nancy M. Dunbar
- Department of Pathology and Medicine; Norris Cotton Cancer Center; Dartmouth-Hitchcock Medical Center
| | - Kenneth R. Meehan
- Department of Hematology; Norris Cotton Cancer Center; Dartmouth-Hitchcock Medical Center
| | | | - Frederick Lansigan
- Department of Hematology; Norris Cotton Cancer Center; Dartmouth-Hitchcock Medical Center
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47
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Dumont LJ, Cancelas JA, Maes LA, Rugg N, Whitley P, Herschel L, Siegal AH, Szczepiorkowski ZM, Hess JR, Zia M. Overnight, room temperature hold of whole blood followed by 42-day storage of red blood cells in additive solution-7. Transfusion 2014; 55:485-90. [PMID: 25234026 DOI: 10.1111/trf.12868] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/22/2014] [Accepted: 07/23/2014] [Indexed: 12/01/2022]
Abstract
BACKGROUND Overnight, room temperature hold (ONH) of whole blood before component processing offers several benefits. This study evaluated the storage and in vivo recovery characteristics of ONH red blood cells (RBCs) stored in additive solution-7 (AS-7). STUDY DESIGN AND METHODS We conducted a three-center, three-arm evaluation of a new blood collection system with AS-7 compared to leukoreduced RBCs processed within 8 hours and stored in AS-1 (control). Whole blood (500 ± 50 mL) from healthy research subjects (n = 240) was held at room temperature 0 to 2 hours, 6 to 8 hours, or ONH (18-24 hr) before component processing and storage at 1 to 6 °C. RBCs were evaluated on Days 42 and 56 with a panel of in vitro assays. Subsets of the AS-7-stored RBCs were evaluated for (51) Cr 24-hour in vivo recovery and long-term survival. RESULTS Adenosine triphosphate (ATP) levels in ONH RBCs were not different than AS-7 RBCs prepared within 8 hours. ATP was higher in the ONH group on Day 42 than control, and ATP was maintained in all AS-7 groups through Day 56. ONH units had 0.36 ± 0.14% on Day 42 hemolysis (60/60 < 0.8%), and 0.54 ± 0.22% on Day 56 (10/60 > 0.8%, 2/60 > 1%). In vivo recoveries of stored RBCs were not different between the AS-7 arms at 42 days (p = 0.16; 27/27 ONH units > 75%), but the Day 56 ONH was significantly less than ONH on Day 42 (p = 0.008; 7/28 < 75%). CONCLUSIONS Overnight hold of whole blood at room temperature before component processing meets current regulatory requirements when RBCs are stored up to 42 days in AS-7.
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Affiliation(s)
- Larry J Dumont
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Dumont LJ, Cancelas JA, Maes LA, Rugg N, Whitley P, Herschel L, Siegel AH, Szczepiorkowski ZM, Hess JR, Zia M. The bioequivalence of frozen plasma prepared from whole blood held overnight at room temperature compared to fresh-frozen plasma prepared within eight hours of collection. Transfusion 2014; 55:476-84. [PMID: 25233805 DOI: 10.1111/trf.12864] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 07/24/2014] [Accepted: 07/24/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Overnight, room temperature hold of whole blood (WB) before leukoreduction and component processing offers significant logistic and cost advantages over WB processed within 8 hours. Plasma prepared from WB held at room temperature overnight (PF24RT24WB) may result in a degradation of plasma coagulation protein activities compared to plasma frozen within 8 hours of collection. In this study, we intended to evaluate the bioequivalence (BE) of PF24RT24WB prepared using a new WB collection, leukoreduction, and storage system compared to fresh-frozen plasma (FFP) after 12 months of frozen storage. STUDY DESIGN AND METHODS We conducted a three-center, three-arm evaluation of the LEUKOSEP HWB-600-XL test system (Hemerus Medical LLC) compared to the RZ2000 control (Fenwal, Inc.). FFP was prepared from WB held at room temperature more than 6 hours and placed at less than -18 °C by 8 hours for control (n = 60) and test (n = 60) arms. PF24RT24WB (n = 60) was prepared with the test system from WB held at room temperature and then filtered and processed 20 to 24 hours postcollection. Frozen plasma was tested at 3, 6, and 12 months using a comprehensive panel of protein and coagulation factor assays. RESULTS The test FFP was BE for all coagulation factors and tested proteins at 12 months. As expected, PF24RT24WB had a reduced Factor (F)VIII activity compared to control FFP (87.1%; 90% confidence interval, 79.4%-93.3%) with the lower confidence limit less than 80%. All other factors were within the BE region. CONCLUSION Leukoreduced FFP and PF24RT24WB prepared using the LEUKOSEP HWB-600-XL system has been shown to be BE to control leukoreduced FFP with an expected decrease in FVIII activity after overnight hold.
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Affiliation(s)
- Larry J Dumont
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Morgan SM, Shaz BH, Pavenski K, Meyer EK, Delaney M, Szczepiorkowski ZM. The top clinical trial opportunities in therapeutic apheresis and neurology. J Clin Apher 2014; 29:331-5. [DOI: 10.1002/jca.21339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 05/23/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Shanna M. Morgan
- Department of Laboratory Medicine and Pathology; University of Minnesota; Minneapolis Minnesota
| | | | - Katerina Pavenski
- Department of Laboratory Medicine; St. Michael's Hospital, University of Toronto; Toronto Ontario Canada
- Department of Laboratory Medicine and Pathobiology; University of Toronto; Toronto Ontario Canada
| | - Erin K. Meyer
- Department of Pathology and Laboratory Medicine; Emory University School of Medicine; Atlanta Georgia
| | - Meghan Delaney
- Puget Sound Blood Center; University of Washington; Seattle Washington
- Department of Laboratory Medicine; University of Washington; Seattle Washington
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Yerrabothala S, Desrosiers KP, Szczepiorkowski ZM, Dunbar NM. Significant reduction in red blood cell transfusions in a general hospital after successful implementation of a restrictive transfusion policy supported by prospective computerized order auditing. Transfusion 2014; 54:2640-5. [PMID: 24673396 DOI: 10.1111/trf.12627] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2013] [Revised: 01/08/2014] [Accepted: 01/24/2014] [Indexed: 01/09/2023]
Abstract
BACKGROUND Our hospital transfusion policy was recently revised to recommend single-unit red blood cell transfusion (RBC TXN) for nonbleeding inpatients when the hemoglobin (Hb) level is not more than 7 g/dL. Our computerized provider order entry system was reconfigured to provide real-time decision support using prospective computerized order auditing based on the most recent Hb level and to remove the single-click ordering option for 2-unit RBC TXNs to enhance compliance. This study was undertaken to assess the impact of these changes on hospital transfusion practice. STUDY DESIGN AND METHODS This study analyzed the total number of transfusion events, proportion of single and 2-unit transfusions and the Hb transfusion trigger in the preimplementation period (October 2011-March 2012) compared to the postimplementation period (October 2012-March 2013). RESULTS In the postimplementation period the total number of RBC units transfused/1000 patient-days decreased from 60.8 to 44.2 (p < 0.0001). The proportion of 2-unit TXNs decreased from 47% to 15% (p < 0.0001). We also observed significant decreases in pretransfusion Hb triggers. CONCLUSION Implementation of restrictive transfusion policy supported by prospective computerized order auditing has resulted in significantly decreased RBC utilization at our institution.
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Affiliation(s)
- Swaroopa Yerrabothala
- Department of Pathology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; Department of Medicine, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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