1
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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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2
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DeSimone RA, Plimier C, Goel R, Hendrickson JE, Josephson CD, Patel RM, Sola-Visner M, Roubinian NH. Associations of donor, component, and recipient factors on hemoglobin increments following red blood cell transfusion in very low birth weight infants. Transfusion 2023; 63:1424-1429. [PMID: 37387597 PMCID: PMC10530070 DOI: 10.1111/trf.17468] [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: 03/04/2023] [Revised: 05/18/2023] [Accepted: 05/31/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Anemia in very low birth weight (VLBW) infants is common and frequently managed with red blood cell (RBC) transfusions. We utilized a linked vein-to-vein database to assess the role of blood donors and component factors on measures of RBC transfusion effectiveness in VLBW infants. STUDY DESIGN AND METHODS We linked blood donor and component manufacturing data with VLBW infants transfused RBCs between January 1, 2013 and December 31, 2016 in the Recipient Epidemiology Donor Evaluation Study-III (REDS III) database. Using multivariable regression, hemoglobin increments and subsequent transfusion events following single-unit RBC transfusion episodes were examined with consideration of donor, component, and recipient factors. RESULTS Data on VLBW infants (n = 254) who received one or more single-unit RBC transfusions (n = 567 units) were linked to donor demographic and component manufacturing characteristics for analysis. Reduced post-transfusion hemoglobin increments were associated with RBC units donated by female donors (-0.24 g/dL [95% confidence interval (CI) -0.57, -0.02]; p = .04) and donors <25 years old (-0.57 g/dL [95% CI -1.02, -0.11]; p = .02). For RBC units donated by male donors, reduced donor hemoglobin levels were associated with an increased need for subsequent recipient RBC transfusion (odds ratio 3.0 [95% CI 1.3, 6.7]; p < .01). In contrast, component characteristics, storage duration, and time from irradiation to transfusion were not associated with post-transfusion hemoglobin increments. CONCLUSION Donor sex, age, and hemoglobin levels were associated with measures of RBC transfusion effectiveness in VLBW infants. Mechanistic studies are needed to better understand the role of these potential donor factors on other clinical outcomes in VLBW infants.
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Affiliation(s)
- Robert A DeSimone
- Department of Pathology and Laboratory Medicine, Division of Transfusion Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Colleen Plimier
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
| | - Ruchika Goel
- Simmons Cancer Institute, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
- Vitalant, Corporate Medical Affairs, Scottsdale, Arizona, USA
| | - Jeanne E Hendrickson
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Cassandra D Josephson
- Cancer and Blood Disorders Institute, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Ravi M Patel
- Department of Pediatrics, Division of Neonatology, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | - Martha Sola-Visner
- Department of Pediatrics, Division of Newborn Medicine, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Nareg H Roubinian
- Kaiser Permanente Northern California Division of Research, Oakland, California, USA
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California, San Francisco, San Francisco, California, USA
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3
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Chen R, Chen D, Ong S, Lo D, DeSimone RA, Cushing MM, Vasovic LV. Visualization dashboard for blood product inventory management. Transfusion 2023; 63:906-907. [PMID: 37026999 DOI: 10.1111/trf.17354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/08/2023] [Accepted: 03/11/2023] [Indexed: 04/08/2023]
Affiliation(s)
- Robert Chen
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Dennis Chen
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Sidney Ong
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Dian Lo
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Robert A DeSimone
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Ljiljana V Vasovic
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
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4
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Lang EA, An A, Finn S, Prishtina F, DeSimone RA, Nellis ME. Epidemiology of Platelet Transfusions in Hospitalized Children: A Pediatric Hospital Information System Database Study. Hosp Pediatr 2023; 13:283-292. [PMID: 36872254 DOI: 10.1542/hpeds.2022-006832] [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: 03/07/2023]
Abstract
OBJECTIVES To describe the epidemiology and complications of platelet transfusions among hospitalized pediatric patients during 2010 to 2019. METHODS We performed a retrospective cohort study of hospitalized children within the Pediatric Health Information System database. Pediatric encounters receiving at least one platelet transfusion during hospitalization from 2010 to 2019 were identified. Data regarding demographics, diagnoses, procedures required during hospitalization, complications, and outcomes were extracted for eligible encounters. RESULTS Within the Pediatric Health Information System database, 6 284 264 hospitalizations occurred from 2010 to 2019. A total of 244 464 hospitalizations required at least one platelet transfusion, yielding a prevalence of 3.89% (95% confidence interval [CI], 3.87%-3.91%). Transfusion prevalence did not change significantly across the decade (P value = .152). Two-thirds of children receiving platelet transfusions were in their first 6 years of life, and the majority identified as male (55%). Recipients most commonly had diseases of the circulatory system (21%, 52 008 of 244 979), perinatal disorders (16%, 38 054 of 244 979), or diseases of the hematologic/immune systems (15%, 37 466 of 244 979). When adjusted for age, support by extracorporeal membrane oxygenation, mechanical ventilation, surgical intervention, and diagnostic category, the odds of thrombosis, infection, and mortality increased by 2% (odds ratio [OR], 1.02; 95% CI, 1.016-1.020), 3% (OR, 1.03; 95% CI, 1.028-1.033), and 7% (OR, 1.07; 95% CI, 1.067-1.071), respectively, with each additional transfusion. CONCLUSIONS The prevalence of platelet transfusions among pediatric inpatients remained consistent across the decade. Our finding that increasing numbers of transfusions may be associated with elevated morbidity and mortality is consistent with other observation and experimental studies, highlighting the need to be thoughtful in weighing risks and benefits when prescribing repeated platelet transfusions to hospitalized children.
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Affiliation(s)
| | - Anjile An
- Division of Biostatistics, Departments of Population Health Sciences and
| | - Sarah Finn
- Morgan Stanley Children's Hospital Administration, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York; and
| | - Fisnik Prishtina
- Morgan Stanley Children's Hospital Administration, New York-Presbyterian Morgan Stanley Children's Hospital, New York, New York; and
| | - Robert A DeSimone
- Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Marianne E Nellis
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, New York Presbyterian Hospital-Weill Cornell, New York, New York
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5
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DeSimone RA, Hess AS, Rajendran P, Tanaka KA, Cushing MM, Eichbaum Q. Blood utilization in liver transplantation (BUILT): A multidisciplinary survey of transfusion practices. Transfusion 2023; 63:83-91. [PMID: 36377099 DOI: 10.1111/trf.17180] [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: 07/29/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND The purpose of this study was to survey liver transplant centers in the United States to assess baseline practices in blood utilization and identify opportunities for standardization to optimize blood use in these complex cases. STUDY DESIGN AND METHODS Two surveys, one for transfusion medicine physicians and the other for anesthesiologists, were distributed to high-volume liver transplant centers. RESULTS The response rate was 52% for both surveys. The majority of respondents (90%) indicated they issue a standardized number of blood products to start surgeries. The most common number of products issued before the start of cases were 10 red blood cells (RBC) and 10 plasma units with no platelets or cryoprecipitate. On average, fewer RBC (7.5) and plasma (7) units were transfused than issued. Decisions to transfuse RhD+ RBCs to RhD- patients and use antigen untested units in alloimmunized patients were mainly handled on a case-by-case basis. Many centers reported utilizing viscoelastic testing (97%) and cell salvage (97%). Most centers reported standardized, laboratory-based intraoperative transfusion goals for RBCs (65%) and fibrinogen replacement (52%) but lacked a standardized approach for plasma (55%) and platelets (58%). DISCUSSION More blood products are issued during surgery than are transfused. Responses from anesthesiology providers suggest a broad consensus on practice. Almost all respondents use viscoelastic testing in the management of intraoperative coagulopathy, either alone or in combination with classical coagulation tests. The majority of programs do not transfuse clotting factor concentrates, including fibrinogen concentrate, prothrombin complex concentrates, and recombinant activated FVII, and do not use antifibrinolytics prophylactically.
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Affiliation(s)
- Robert A DeSimone
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York, USA
| | - Aaron S Hess
- Departments of Anesthesiology and Pathology and Laboratory Medicine, University of Wisconsin, Madison, Wisconsin, USA
| | - Pranesh Rajendran
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York, USA
| | - Kenichi A Tanaka
- Department of Anesthesiology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York, USA
| | - Quentin Eichbaum
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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6
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Makhani SS, Schwartz J, Vasovic LV, DeSimone RA, Kaicker S, Bussel J, Crowe EP, Bloch EM, Tobian AAR, Goel R. Therapeutic plasma exchange practices in immune thrombocytopenia related hospitalizations: Results from a nationally representative sample. J Clin Apher 2022; 37:507-511. [PMID: 35979873 DOI: 10.1002/jca.22000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/15/2022] [Accepted: 07/18/2022] [Indexed: 11/07/2022]
Abstract
Per the American Society for Apheresis, therapeutic plasma exchange (TPE) is a Category III indication in the management of immune thrombocytopenia (ITP). This nationally representative study evaluates TPE utilization in hospitalized adults with a primary admission diagnosis of ITP. Hospitalizations with ITP as the primary admitting diagnosis were analyzed from the 2010 to 2014 National Inpatient Sample, the largest all-payer inpatient database in the United States. Univariate and multivariable logistic regressions were used to determine clinical outcomes in ITP patients undergoing TPE. Sampling weights were applied to generate nationally representative estimates. From 2010 to 2014, there were a total of 56,149 admissions with a primary admitting diagnosis of ITP, of which 0.66% admissions (n = 372) also coded TPE. Most subjects undergoing TPE were the highest disease severity class: major (34.6%) and extreme severity (31.0%), by all-patients refined diagnoses-related groups severity of illness subclass. After multivariable analysis, underlying severity of illness remained the most significant predictor of TPE (P < .001). ITP admissions with TPE had a high rate of comorbidities (50%) and significantly longer mean length of hospital stay than those without (P < .001). TPE was reported in ~0.6% of hospitalizations with ITP as the primary diagnosis in this nationally representative sample from 2010 to 2014. TPE was performed in patients with the highest severity of underlying illness, and higher rates of comorbidities.
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Affiliation(s)
- Sarah S Makhani
- Department of Medicine, NYU Langone Health, New York, New York, USA
| | - Joseph Schwartz
- Department of Pathology, Mount Sinai Hospital, New York, New York, USA
| | - Ljiljana V Vasovic
- Department of Pathology, Weill Cornell Medicine, New York, New York, USA
| | - Robert A DeSimone
- Department of Pathology, Weill Cornell Medicine, New York, New York, USA
| | - Shipra Kaicker
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, New York Presbyterian Hospital Weill Cornell Medicine, New York, New York, USA
| | - James Bussel
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, New York Presbyterian Hospital Weill Cornell Medicine, New York, New York, USA
| | - Elizabeth P Crowe
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Evan M Bloch
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Aaron A R Tobian
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ruchika Goel
- Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA.,ImpactLife Blood Services and Simmons Cancer Institute, SIU School of Medicine, Springfield, IL, USA., Springfield, Illinois, USA
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7
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DeSimone RA, Vinchi F. Screening out the Exposome to Improve Transfusion Quality. Hemasphere 2021; 5:e605. [PMID: 34235402 PMCID: PMC8232066 DOI: 10.1097/hs9.0000000000000605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Robert A. DeSimone
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, USA
- Lindsley Kimball Research Institute, New York Blood Center, New York, USA
| | - Francesca Vinchi
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, USA
- Lindsley Kimball Research Institute, New York Blood Center, New York, USA
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8
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Nedumcheril MT, DeSimone RA, Racine-Brzostek SE, Chaekal OK, Vasovic LV. Overcoming Drug Interference in Transfusion Testing: A Spotlight on Daratumumab. J Blood Med 2021; 12:327-336. [PMID: 34079412 PMCID: PMC8164699 DOI: 10.2147/jbm.s213510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 02/20/2021] [Accepted: 04/29/2021] [Indexed: 12/01/2022] Open
Abstract
Daratumumab, a monoclonal antibody therapeutic, is highly efficacious and widely used in all stages of multiple myeloma and amyloidosis and has promising activity in other hematologic disorders. Daratumumab interacts with red blood cells, interfering with pre-transfusion testing. This interference can lead to compromising transfusion safety, extensive blood bank work ups and delays in provision of compatible units. Several methods have been developed to negate daratumumab interference with indirect antiglobulin testing. They are based on i) standard blood bank techniques including dithiothreitol and enzymatic treatment of reagent cells, using reagent red blood cells negative for CD38, ii) blocking CD38 antigens on reagent or donor cells, iii) neutralization of anti-CD38 antibody in patient plasma prior to testing, and iv) extended antigen typing of patient red blood cells in conjunction with provision of phenotypically matched units for transfusion. Implementation of those methods by the blood bank should be a planned effort coordinated with the patient’s clinical team. Timely involvement of blood bank and transfusion services and educational efforts by both blood banks and clinical providers can improve the overall daratumumab safety profile in regard to blood transfusion.
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Affiliation(s)
- Marilyn T Nedumcheril
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.,New York Blood Center Enterprises, New York, NY, USA
| | - Robert A DeSimone
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Sabrina E Racine-Brzostek
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Ok Kyong Chaekal
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA.,Department of Medicine/Division of Hematology-Oncology New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
| | - Ljiljana V Vasovic
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY, USA
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9
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Karafin MS, Becker JL, Berg M, DeSimone RA, Draper NL, Hudgins J, Metcalf RA, Pagano MB, Park YA, Rossmann SN, Schwartz J, Souers R, Thomas L, Uhl L, Ramsey GE. Heterogeneity in Approaches for Switching From Universal to Patient ABO Type-Specific Blood Components During Massive Hemorrhage: An International Survey and Review of the Literature. Arch Pathol Lab Med 2021; 145:1499-1504. [PMID: 33720316 DOI: 10.5858/arpa.2020-0374-cp] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— ABO mistransfusions are rare and potentially fatal events. Protocols are required by regulatory agencies to minimize this risk to patients, but how these are applied in the context of massive transfusion protocols (MTPs) is not specifically defined. OBJECTIVE.— To evaluate the approaches used by transfusion services for switching from universally compatible to patient ABO type-specific blood components during massive hemorrhage. DESIGN.— We added 1 supplemental multiple-choice question to address the study objective to the 2019 College of American Pathologists proficiency test J-survey (J-A 2019). We also reviewed the available literature regarding this topic. RESULTS.— A total of 881 laboratories responded to the supplemental question. Approximately 80% (704 of 881) report a policy for ABO-type switching during an MTP. Policies varied considerably between responding laboratories, but most (384 of 704, 55%) required 2 ABO types to match before switching from universal to recipient-specific blood components. Additional safety measures used in a minority of these protocols included reaction strength criteria (103 of 704, 15%), on-call medical director approval (41 0f 704, 5.8%), universal red cell unit number limits (12 of 704, 1.7%), or the presence of a mixed field (3 of 704, 0.4%). CONCLUSIONS.— This survey reveals that significant heterogeneity exists regarding the available approaches for ABO-type switching during an MTP. Specific expert guidance regarding this issue is very limited, and best practices have not yet been established or rigorously investigated.
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Affiliation(s)
- Matthew S Karafin
- From Versiti, Medical Sciences Institute, Milwaukee, Wisconsin (Karafin).,Karafin is currently located in the Department of Pathology at the University of North Carolina, Chapel Hill.,The Department of Pathology, Medical College of Wisconsin, Milwaukee (Karafin)
| | - Joanne L Becker
- The Department of Pathology, Roswell Park Comprehensive Cancer Center, Buffalo, New York (Becker)
| | - Mary Berg
- The Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora (Berg, Draper)
| | - Robert A DeSimone
- The Department of Pathology and Laboratory Medicine, Weill Cornell Medical Center, New York, New York (DeSimone)
| | - Nicole L Draper
- The Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora (Berg, Draper)
| | - Jay Hudgins
- The Department of Pathology, Los Angeles Children's Hospital, University of Southern California Medical Center, Los Angeles, California (Hudgins)
| | - Ryan A Metcalf
- ARUP Blood Services, 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
- The Department of Pathology and Laboratory Medicine, University of North Carolina Hospitals, Chapel Hill (Park)
| | | | - Joseph Schwartz
- The Department of Pathology, Columbia University Medical Center, New York, New York (Schwartz)
| | - Rhona Souers
- Statistics (Souers) and PT - Technical & Administration (Thomas), College of American Pathologists, Northfield, Illinois
| | - Lamont Thomas
- Statistics (Souers) and PT - Technical & Administration (Thomas), College of American Pathologists, Northfield, Illinois
| | - Lynne Uhl
- The Department of Laboratory and Transfusion Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Uhl)
| | - Glenn E Ramsey
- The Department of Pathology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois (Ramsey)
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10
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Rendeiro AF, Casano J, Vorkas CK, Singh H, Morales A, DeSimone RA, Ellsworth GB, Soave R, Kapadia SN, Saito K, Brown CD, Hsu J, Kyriakides C, Chiu S, Cappelli LV, Cacciapuoti MT, Tam W, Galluzzi L, Simonson PD, Elemento O, Salvatore M, Inghirami G. Profiling of immune dysfunction in COVID-19 patients allows early prediction of disease progression. Life Sci Alliance 2021; 4:e202000955. [PMID: 33361110 PMCID: PMC7768198 DOI: 10.26508/lsa.202000955] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 01/08/2023] Open
Abstract
With a rising incidence of COVID-19-associated morbidity and mortality worldwide, it is critical to elucidate the innate and adaptive immune responses that drive disease severity. We performed longitudinal immune profiling of peripheral blood mononuclear cells from 45 patients and healthy donors. We observed a dynamic immune landscape of innate and adaptive immune cells in disease progression and absolute changes of lymphocyte and myeloid cells in severe versus mild cases or healthy controls. Intubation and death were coupled with selected natural killer cell KIR receptor usage and IgM+ B cells and associated with profound CD4 and CD8 T-cell exhaustion. Pseudo-temporal reconstruction of the hierarchy of disease progression revealed dynamic time changes in the global population recapitulating individual patients and the development of an eight-marker classifier of disease severity. Estimating the effect of clinical progression on the immune response and early assessment of disease progression risks may allow implementation of tailored therapies.
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Affiliation(s)
- André F Rendeiro
- Institute of Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Joseph Casano
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Charles Kyriakos Vorkas
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Harjot Singh
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Ayana Morales
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Robert A DeSimone
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Grant B Ellsworth
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Rosemary Soave
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Shashi N Kapadia
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Kohta Saito
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Christopher D Brown
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - JingMei Hsu
- Division of Hematology/Oncology, Department of Medicine Weill Cornell Medicine, New York, NY, USA
| | - Christopher Kyriakides
- Department of Rehabilitation Medicine at New York University Grossman School of Medicine New York, NY, USA
| | - Steven Chiu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Luca Vincenzo Cappelli
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Wayne Tam
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lorenzo Galluzzi
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA
- Sandra and Edward Meyer Cancer Center, New York, NY, USA
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Paul D Simonson
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Olivier Elemento
- Institute of Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mirella Salvatore
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Division of Public Health Programs, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Giorgio Inghirami
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
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11
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Vossoughi S, Fischkoff K, DeSimone RA, Schwartz J. Blood stewardship: conservation and supply of blood components during the severe acute respiratory syndrome coronavirus 2 pandemic. Transfusion 2020; 60:2156-2158. [PMID: 32672371 PMCID: PMC7404962 DOI: 10.1111/trf.15995] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 06/12/2020] [Accepted: 06/13/2020] [Indexed: 12/02/2022]
Affiliation(s)
- Sarah Vossoughi
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
| | - Katherine Fischkoff
- Department of Surgery and Critical Care, Columbia University Irving Medical Center, New York, New York, USA
| | - Robert A DeSimone
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Joseph Schwartz
- Department of Pathology and Cell Biology, Columbia University Irving Medical Center, New York, New York, USA
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12
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DeSimone RA, Costa VA, Kane K, Sepulveda JL, Ellsworth GB, Gulick RM, Zucker J, Sobieszcyk ME, Schwartz J, Cushing MM. Blood component utilization in COVID-19 patients in New York City: Transfusions do not follow the curve. Transfusion 2020; 61:692-698. [PMID: 33215718 PMCID: PMC7753518 DOI: 10.1111/trf.16202] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 10/30/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022]
Abstract
Background Blood suppliers and transfusion services have worked diligently to maintain an adequate blood supply during the COVID‐19 pandemic. Our experience has shown that some COVID‐19 inpatients require transfusion support; understanding this need is critical to blood product inventory management. Study Design and Methods Hospital‐wide and COVID‐19 specific inpatient blood product utilization data were collected retrospectively for our networkʼs two tertiary academic medical centers over a 9‐week period (March 1, 2020‐May 2, 2020), when most inpatients had COVID‐19. Utilization data were merged with a COVID‐19 patient database to investigate clinical demographic characteristics of transfused COVID‐19 inpatients relative to non‐transfused ones. Results Overall, 11 041 COVID‐19 patients were admitted and 364 received blood product transfusions for an overall transfusion rate of 3.3%. COVID‐19 patients received 1746 blood components in total, the majority of which were red blood cells. COVID‐19 patientsʼ weekly transfusion rate increased as the pandemic progressed, possibly reflecting their increased severity of illness. Transfusion was significantly associated with several indicators of severe disease, including mortality, intubation, thrombosis, longer hospital admission, lower hemoglobin and platelet nadirs, and longer prothrombin and activated partial thromboplastin times. As the pandemic progressed, institutional adherence to transfusion guidelines improved for RBC transfusions compared to prior year trends but did not improve for platelets or plasma. Conclusion There is a need to closely monitor the blood product inventory and demand throughout the COVID‐19 pandemic as patientsʼ transfusion needs may increase over time. Daily or weekly trending of patientsʼ clinical status and laboratory values may assist blood banks in inventory management.
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Affiliation(s)
- Robert A DeSimone
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York, USA
| | - Victoria A Costa
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York, USA
| | - Kathleen Kane
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York, USA.,Department of Pathology and Cell Biology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Jorge L Sepulveda
- Department of Pathology and Cell Biology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Grant B Ellsworth
- Division of Infectious Diseases, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York, USA
| | - Roy M Gulick
- Division of Infectious Diseases, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York, USA
| | - Jason Zucker
- Division of Infectious Diseases, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Magdalena E Sobieszcyk
- Division of Infectious Diseases, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Joseph Schwartz
- Department of Pathology and Cell Biology, New York-Presbyterian Hospital-Columbia University Irving Medical Center, New York, New York, USA
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital-Weill Cornell Medicine, New York, New York, USA
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13
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Rendeiro AF, Casano J, Kyriakos Vorkas C, Singh H, Morales A, DeSimone RA, Ellsworth GB, Soave R, Kapadia SN, Saito K, Brown CD, Hsu J, Kyriakides C, Chiu S, Cappelli L, Teresa Cacciapuoti M, Tam W, Galluzzi L, Simonson PD, Elemento O, Salvatore M, Inghirami G. Longitudinal immune profiling of mild and severe COVID-19 reveals innate and adaptive immune dysfunction and provides an early prediction tool for clinical progression. medRxiv 2020:2020.09.08.20189092. [PMID: 32935114 PMCID: PMC7491529 DOI: 10.1101/2020.09.08.20189092] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
With a rising incidence of COVID-19-associated morbidity and mortality worldwide, it is critical to elucidate the innate and adaptive immune responses that drive disease severity. We performed longitudinal immune profiling of peripheral blood mononuclear cells from 45 patients and healthy donors. We observed a dynamic immune landscape of innate and adaptive immune cells in disease progression and absolute changes of lymphocyte and myeloid cells in severe versus mild cases or healthy controls. Intubation and death were coupled with selected natural killer cell KIR receptor usage and IgM+ B cells and associated with profound CD4 and CD8 T cell exhaustion. Pseudo-temporal reconstruction of the hierarchy of disease progression revealed dynamic time changes in the global population recapitulating individual patients and the development of an eight-marker classifier of disease severity. Estimating the effect of clinical progression on the immune response and early assessment of disease progression risks may allow implementation of tailored therapies.
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Affiliation(s)
- André F Rendeiro
- Institute of Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Joseph Casano
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Charles Kyriakos Vorkas
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Harjot Singh
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Ayana Morales
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Robert A DeSimone
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Grant B Ellsworth
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Rosemary Soave
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Shashi N Kapadia
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
| | - Kohta Saito
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Christopher D Brown
- Division of Infectious Diseases, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - JingMei Hsu
- Division of Hematology/Oncology, Department of Medicine Weill Cornell Medicine, New York, NY, 10065, USA
| | - Christopher Kyriakides
- Department of Rehabilitation Medicine at NYU Grossman School of Medicine New York, NY, USA
| | - Steven Chiu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Luca Cappelli
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | | | - Wayne Tam
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Lorenzo Galluzzi
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Radiation Oncology, Weill Cornell Medical College, New York, NY, USA
- Sandra and Edward Meyer Cancer Center, New York, NY, USA
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Paul D Simonson
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Olivier Elemento
- Institute of Computational Biomedicine, Weill Cornell Medicine, New York, NY, USA
- Caryl and Israel Englander Institute for Precision Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Mirella Salvatore
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, USA
- Division of Public Health Programs, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Giorgio Inghirami
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
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14
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Racine-Brzostek SE, Canver MC, DeSimone RA, Zdravkova M, Lo DT, Crowley KM, Hsu YMS, Vasovic LV, Hill SS, Cushing MM. Thawed solvent/detergent-treated plasma demonstrates comparable clinical efficacy to thawed plasma. Transfusion 2020; 60:1940-1949. [PMID: 32720432 DOI: 10.1111/trf.15948] [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: 09/19/2019] [Revised: 05/31/2020] [Accepted: 05/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Thawed Plasma (TP), plasma thawed and refrigerated for up to 5 days, is a commonly transfused plasma product. This pilot study was conducted to determine whether Thawed Solvent/Detergent-treated Plasma stored refrigerated for up to 5-days post-thaw (T-S/D) was as efficacious as TP. STUDY DESIGN AND METHODS This single institution retrospective cohort analysis evaluated the efficacy of T-S/D in reversing coagulopathies in comparison to TP. Utilizing the institution's electronic medical records, transfusion data were collected in adult patients who received either TP or T-S/D. The primary outcome was the incidence of subsequent transfusions within 24 hours after first dose of either type of plasma. Secondary outcomes included the number of blood products transfused within 24 hours of first-dose plasma, correction of pre-transfusion coagulation laboratory values, volume transfused, and clinical outcomes. RESULTS TP was received by 301 patients and 137 received T-S/D during the first 32 months post-implementation of T-S/D. There was no difference in incidence of subsequent transfusions or number of blood products given. The median pre-INR of both the TP and T-S/D cohorts was 1.9, with a similar decrease in INR of 0.2 and 0.3 (p = 0.36), respectively, post plasma transfusion. There was no difference in correction of PT/aPTT, mortality, transfusion reactions, readmission rates, length of stay, or inpatient deep venous thrombosis. The median volume of T-S/D plasma transfused for the first dose was 126 mL less than TP (p = .0001). CONCLUSION T-S/D was as efficacious as TP for the treatment of coagulopathies and the reversal of coagulation laboratory values.
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Affiliation(s)
- Sabrina E Racine-Brzostek
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA.,New York Blood Center, New York, New York, USA
| | - Matthew C Canver
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Robert A DeSimone
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Milena Zdravkova
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Dian T Lo
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Kathleen M Crowley
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Yen-Michael S Hsu
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Ljiljana V Vasovic
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Shanna Sykes Hill
- Department of Anesthesiology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York, USA
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15
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Dillard A, DeSimone RA, Hsu YM, Ma L, Vasovic L, Racine-Brzostek S, Ivascu N, Haas T, Cushing MM. Flat line in the blood bank: code H (hyperfibrinolysis)? Transfusion 2020; 60:1894-1896. [PMID: 32609379 DOI: 10.1111/trf.15923] [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: 01/02/2020] [Revised: 04/21/2020] [Accepted: 05/03/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Alicia Dillard
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA.,Department of Transfusion Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Robert A DeSimone
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA.,Department of Transfusion Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Yen-Michael Hsu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA.,Department of Transfusion Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Lucy Ma
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA.,Department of Transfusion Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Ljiljana Vasovic
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA.,Department of Transfusion Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Sabrina Racine-Brzostek
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA.,Department of Transfusion Medicine, NewYork-Presbyterian Hospital, New York, New York, USA
| | - Natalia Ivascu
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Thorsten Haas
- Department of Anesthesiology, University Children's Hospital Zurich, Zurich, Switzerland
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA.,Department of Transfusion Medicine, NewYork-Presbyterian Hospital, New York, New York, USA.,Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
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16
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Barone P, DeSimone RA. Convalescent plasma to treat coronavirus disease 2019 (COVID-19): considerations for clinical trial design. Transfusion 2020; 60:1123-1127. [PMID: 32374891 PMCID: PMC7267607 DOI: 10.1111/trf.15843] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 04/25/2020] [Indexed: 12/17/2022]
Abstract
Case series studying convalescent plasma use in the treatment of COVID‐19 have been promising, but additional, high‐quality studies are needed to determine the efficacy of the treatment when applied for prophylaxis, for early phases of illness, and for severe illness. Previous studies of convalescent plasma in treating other viral diseases have identified factors to consider when designing treatment protocols, including timing of administration relative to onset of illness, timing of donation relative to resolution of symptoms, severity of illness of the donor, pretransfusion serology of the recipient, and antibody titers of the donor. There are many clinical trials studying treatment of, and prophylaxis against, COVID‐19 using convalescent plasma. In addition to clinical trials, the FDA also allows treatment through two other pathways: the “Expanded Access to Convalescent Plasma for the Treatment of Patients with COVID‐19” protocol, and emergency investigational new drug applications. The FDA also provides criteria for donation of convalescent plasma.
See article on page 1332–1333, in this issue
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Affiliation(s)
- Paul Barone
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Robert A DeSimone
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
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17
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DeSimone RA, Plimier C, Lee C, Kanias T, Cushing MM, Sachais BS, Kleinman S, Busch MP, Roubinian NH. Additive effects of blood donor smoking and gamma irradiation on outcome measures of red blood cell transfusion. Transfusion 2020; 60:1175-1182. [DOI: 10.1111/trf.15833] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Colleen Plimier
- Kaiser Permanente Northern California Division of Research Oakland California USA
| | - Catherine Lee
- Kaiser Permanente Northern California Division of Research Oakland California USA
| | | | | | | | | | - Michael P. Busch
- Vitalant Research Institute San Francisco California USA
- University of California San Francisco California USA
| | - Nareg H. Roubinian
- Kaiser Permanente Northern California Division of Research Oakland California USA
- Vitalant Research Institute San Francisco California USA
- University of California San Francisco California USA
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18
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Morales A, Mathur-Wagh U, Tran A, Cui I, DeSimone RA, Jenkins SG, Westblade LF, Jones S. Cavitary Pulmonary Nodules in an Immunocompromised Patient With Urothelial Carcinoma of the Bladder. Clin Infect Dis 2019; 67:1631-1634. [PMID: 30376101 PMCID: PMC7448926 DOI: 10.1093/cid/ciy270] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Affiliation(s)
- Ayana Morales
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York
| | - Usha Mathur-Wagh
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York
| | - Anthony Tran
- New York City Department of Health and Mental Hygiene, New York
| | - Isabelle Cui
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York
| | - Robert A DeSimone
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York
| | - Stephen G Jenkins
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York
| | - Lars F Westblade
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York.,Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York
| | - Sian Jones
- Department of Medicine, Division of Infectious Diseases, Weill Cornell Medicine, New York
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19
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Vasovic LV, DeSimone RA. Increase in Google search interest for paid plasma donation in the United States during and after the great recession. Transfusion 2019; 59:3056-3057. [DOI: 10.1111/trf.15468] [Citation(s) in RCA: 3] [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: 06/26/2019] [Accepted: 07/16/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Ljiljana V. Vasovic
- Department of Pathology and Laboratory MedicineWeill Cornell Medicine New York New York
| | - Robert A. DeSimone
- Department of Pathology and Laboratory MedicineWeill Cornell Medicine New York New York
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20
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DeSimone RA, Hayden JA, Mazur CA, Vasovic LV, Sachais BS, Zhao Z, Goel R, Hsu YMS, Racine-Brzostek SE, Cushing MM. Red blood cells donated by smokers: A pilot investigation of recipient transfusion outcomes. Transfusion 2019; 59:2537-2543. [PMID: 31074905 DOI: 10.1111/trf.15339] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 04/10/2019] [Accepted: 04/21/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND Current regulations do not require blood collection facilities to ask donors about cigarette smoking, and the prevalence of nicotine and its metabolites in blood products is not well established. Although smokers have higher hemoglobin (Hb) levels, smoking may adversely affect the quality of donated red blood cells through higher carboxyhemoglobin (COHb) content and premature hemolysis. STUDY DESIGN AND METHODS Red blood cell (RBC) unit segments from 100 unique donors were tested for nicotine and its metabolite cotinine by mass spectrometry and for COHb spectrophotometrically. Outcomes were evaluated retrospectively in adult non-bleeding patients receiving single RBC units. RESULTS Thirteen of 100 RBC segments (13%) were positive for cotinine at levels consistent with current smoking (> 10 ng/mL). The cotinine positive RBCs showed significantly greater COHb content compared to cotinine negative units (median 3.0% vs. 0.8%, p = 0.007). For patients transfused cotinine-positive units, there was no significant change in their vital signs following transfusion and no transfusion reactions were observed. However, patients transfused cotinine-positive units showed significantly reduced hematocrit and hemoglobin increments (median +1.2% and +0.4 g/dL) following transfusion compared to patients receiving cotinine negative units (median +3.6% and +1.4 g/dL) (p = 0.014). CONCLUSION Thirteen percent of RBC units tested positive for cotinine at levels consistent with active smoking, accordant with the estimated national smoking rate of 15.5%. Cotinine-positive RBC units had greater COHb content and showed reduced hematocrit and hemoglobin increments following transfusion. These preliminary results should be validated in a larger cohort.
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Affiliation(s)
- Robert A DeSimone
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Joshua A Hayden
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Chase A Mazur
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Ljiljana V Vasovic
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | | | - Zhen Zhao
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Ruchika Goel
- Simmons Cancer Institute at Southern Illinois University School of Medicine, Springfield, Illinois.,Department of Pathology, Johns Hopkins University, Baltimore, Maryland
| | - Yen-Michael S Hsu
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Sabrina E Racine-Brzostek
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.,New York Blood Center, New York, New York
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
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21
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DeSimone RA, Ong SJ, Crowley KM, Vasovic LV, Senaldi E, Kessler DA, Goel R, Hsu YMS. Hereditary elliptocytosis of donor red blood cell unit detected during Coombs crossmatch. Transfusion 2019; 59:446-447. [PMID: 30727041 DOI: 10.1111/trf.14981] [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: 05/14/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Robert A DeSimone
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York.,New York Blood Center, New York, New York
| | - Sidney J Ong
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Kathleen M Crowley
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Ljiljana V Vasovic
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | | | | | - Ruchika Goel
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Yen-Michael S Hsu
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
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22
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Cushing MM, Asmis LM, Harris RM, DeSimone RA, Hill S, Ivascu N, Haas T. Efficacy of a new pathogen-reduced cryoprecipitate stored 5 days after thawing to correct dilutional coagulopathy in vitro. Transfusion 2019; 59:1818-1826. [PMID: 30719724 DOI: 10.1111/trf.15157] [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: 09/23/2018] [Revised: 12/27/2018] [Accepted: 12/29/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Fibrinogen supplementation during bleeding restores clot strength and hemostasis. Cryoprecipitate, a concentrated source of fibrinogen, has prolonged preparation time for thawing, a short shelf life resulting in frequent wastage, and infectious disease risk. This in vitro study investigated the efficacy of a new pathogen-reduced cryoprecipitate thawed and stored at room temperature for 5 days (PR Cryo) to treat dilutional hypofibrinogenemia, compared to immediately thawed standard cryoprecipitate (Cryo) or fibrinogen concentrate (FC). STUDY DESIGN AND METHODS Ten phlebotomy specimens from healthy volunteers were diluted 1:1 with crystalloid and supplemented with PR Cryo and Cryo (at a dose replicating transfusion of two pooled doses [10 units]) and FC at a dose replicating 50 mg/kg. Changes in clot firmness (thromboelastometry) and in coagulation factor activity were assessed at baseline, after dilution, and after supplementation. RESULTS Clinical dosing was used, as described above, and consequently the FC dose contained 24% and 36% more fibrinogen versus PR Cryo and Cryo, respectively. At baseline, subjects had a median FIBTEM maximum clot firmness of 13.5 mm, versus 6.5 mm after 50% dilution (p = 0.005). After supplementation with PR Cryo, a median FIBTEM maximum clot firmness of 13 mm was observed versus 9.0 mm for Cryo (p = 0.005) or 16.5 mm for FC (p = 0.005). Median factor XIII was higher after PR Cryo (64.8%) versus Cryo (48.3%) (p = 0.005). Fibrinogen activity was higher after FC (269.0 mg/dL) versus PR Cryo (187.0 mg/dL; p = 0.005) or Cryo (193.5 mg/dL; p = 0.005); the difference between PR Cryo and Cryo supplementation (p = 0.445) was not significant. CONCLUSION PR Cryo used 5 days after thawing effectively restores clot strength after in vitro dilution.
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Affiliation(s)
- Melissa M Cushing
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York.,Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Lars M Asmis
- Centre for Perioperative Thrombosis and Haemostasis, Zurich, Switzerland
| | - Rebecca M Harris
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Robert A DeSimone
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, New York
| | - Shanna Hill
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Natalia Ivascu
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York
| | - Thorsten Haas
- Department of Anaesthesia, Zurich University Children's Hospital, Zurich, Switzerland
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23
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Cushing MM, DeSimone RA, Goel R, Hsu YMS, Parra P, Racine-Brzostek SE, Degtyaryova D, Lo DT, Morrison M, Crowley KM, Rossi A, Vasovic LV. The impact of Daratumumab on transfusion service costs. Transfusion 2019; 59:1252-1258. [PMID: 30620407 DOI: 10.1111/trf.15134] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 11/14/2018] [Accepted: 11/21/2018] [Indexed: 12/27/2022]
Abstract
BACKGROUND Daratumumab (DARA) is a human IgG1κ monoclonal antibody directed against CD38, approved for the treatment of multiple myeloma. As CD38 is expressed on RBCs, DARA can interfere with pretransfusion testing. DARA interference can be negated by denaturation of CD38 on RBCs with dithiothreitol (DTT) reagents. Because of this interference in pretransfusion testing, our hospital implemented a notification and testing/transfusion algorithm (NATTA) for pretransfusion testing and RBC product provision for DARA patients. This standardized approach combines DTT-based testing with selective genotyping and the provision of phenotypically similar RBCs for patients with clinically significant antibodies. STUDY DESIGN AND METHODS We evaluated pretransfusion test results and transfusion requirements for 91 DARA patients in an academic medical center over 1 year to determine the incremental cost of pretransfusion testing and RBC selection. The actual costs for the NATTA approach were compared to a theoretical approach using universal genotyping with a provision of phenotypically similar RBC transfusions. RESULTS The annual cost of testing related to DARA after NATTA implementation was $535.76 per patient. The simulated annual cost for the alternative genotyping with provision of phenotypically similar RBC transfusions approach was $934.83 per patient. CONCLUSION In our entire cohort of DARA patients, a DTT-based testing algorithm with selective genotyping and provision of phenotypically similar RBCs only for patients with clinically significant antibodies was less expensive than a simulated model of universal genotyping and provision of phenotypically similar RBCs.
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Affiliation(s)
- Melissa M Cushing
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Robert A DeSimone
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Ruchika Goel
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Yen-Michael S Hsu
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Priscilla Parra
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Sabrina E Racine-Brzostek
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Diana Degtyaryova
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Dian T Lo
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Meta Morrison
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Kathleen M Crowley
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Adrianna Rossi
- Department of Medicine/Division of Hematology-Oncology, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Ljiljana V Vasovic
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
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24
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DeSimone RA, Sachais BS. Conservation of O- red blood cells: a fresh look at a shared responsibility. Transfusion 2018; 58:1333-1334. [PMID: 29949194 DOI: 10.1111/trf.14619] [Citation(s) in RCA: 2] [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: 03/01/2018] [Accepted: 03/01/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Robert A DeSimone
- New York Blood Center, New York, NY.,Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, NY
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25
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DeSimone RA, Cushing MM. Heparin-induced thrombocytopenia suggested by microscopic examination of a below-knee amputation. Transfusion 2018; 58:2784-2785. [PMID: 30520089 DOI: 10.1111/trf.14815] [Citation(s) in RCA: 2] [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: 05/13/2018] [Accepted: 05/24/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Robert A DeSimone
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
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26
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DeSimone RA, Myers GD, Guest EM, Shi PA. Combined heparin/acid citrate dextrose solution A anticoagulation in the Optia continuous mononuclear cell protocol for pediatric lymphocyte apheresis. J Clin Apher 2018; 34:487-489. [DOI: 10.1002/jca.21675] [Citation(s) in RCA: 3] [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: 09/11/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 11/07/2022]
Affiliation(s)
- Robert A. DeSimone
- New York Blood Center New York New York
- Department of Pathology and Laboratory MedicineWeill Cornell Medicine New York New York
| | - Gary D. Myers
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow TransplantationChildren's Mercy Kansas City Missouri
| | - Erin M. Guest
- Department of Pediatrics, Division of Hematology/Oncology/Bone Marrow TransplantationChildren's Mercy Kansas City Missouri
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27
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DeSimone RA, Leung WK, Schwartz J. Transfusion Medicine in a Multidisciplinary Approach to Morbidly Adherent Placenta: Preparing for and Preventing the Worst. Transfus Med Rev 2018; 32:244-248. [DOI: 10.1016/j.tmrv.2018.05.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/21/2018] [Accepted: 05/28/2018] [Indexed: 12/17/2022]
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28
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DeSimone RA, Berlin DA, Avecilla ST, Goss CA. Investigational use of PEGylated carboxyhemoglobin bovine in a Jehovah's Witness with hemorrhagic shock. Transfusion 2018; 58:2297-2300. [PMID: 30203845 DOI: 10.1111/trf.14799] [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: 02/04/2018] [Revised: 03/29/2018] [Accepted: 04/19/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND Jehovah's Witnesses pose a clinical challenge in the setting of critical anemia. Most do not accept transfusions, but some accept hemoglobin-based oxygen carriers on a compassionate-use basis. PEGylated carboxyhemoglobin bovine (PCHB) is an acellular dual-action carbon monoxide (CO)-releasing and oxygen transfer agent currently being investigated in Phase II clinical trials. CASE REPORT We present the case of a 42-year-old Jehovah's Witness with an acute upper gastrointestinal bleed and hemorrhagic shock who required emergent PCHB for stabilization during lifesaving interventions. After PCHB infusion, the patient's shock and encephalopathy improved with decreased vasopressor requirement. Through gastroenterology and interventional radiology procedures, the patient's bleeding stabilized. While receiving five additional doses of PCHB and other supportive therapies (iron, folate, vitamin B12, darbepoetin alfa), the patient was extubated and weaned off vasopressors. CONCLUSIONS PCHB was used to stabilize (bridge) a critically ill anemic patient for lifesaving interventions without adverse effects. Additional studies are warranted to explore the drug's safety profile and efficacy in patients declining blood products.
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Affiliation(s)
| | - David A Berlin
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, New York-Presbyterian Hospital-Weill Cornell Medicine
| | - Scott T Avecilla
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Cheryl A Goss
- Department of Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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29
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DeSimone RA, Nowak MD, Lo DT, Crowley KM, Parra P, Cushing MM, Hsu YMS. Logistical and safety implications of temperature-based acceptance of returned red blood cell units. Transfusion 2018; 58:1500-1505. [PMID: 29624677 DOI: 10.1111/trf.14615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/02/2018] [Accepted: 02/01/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND AABB requires that red blood cells (RBCs) are maintained at 1 to 10°C during transport. Historically, blood banks used the 30-minute rule for returned RBCs transported outside of validated containers. The implications of this policy have not been previously reported in a real-life hospital setting. STUDY DESIGN AND METHODS A 2-year, retrospective review of RBC units returned outside of qualified containers was conducted. During the first year, the 30-minute rule was used to accept RBCs back into inventory. Sequentially, the following year, a temperature-based approach was implemented using a thermometer with an accuracy of ±1°C. Time out of the blood bank, temperature upon return, wastage, and transfusion reactions associated with the reissued RBCs were analyzed. RESULTS In our practice, the 30-minute rule would have accepted 15.2% of RBC units outside of the allowed temperature. Compared to the 30-minute rule, temperature-based acceptance was associated with a 13% increase in wastage (p < 0.001). During the 30-minute rule period, transfusion of returned and subsequently reissued RBCs was associated with a nonsignificant trend toward a higher transfusion reaction rate compared to the overall RBC transfusion reaction rate (1.4% vs. 0.6%, p = 0.084). During the temperature period, transfusion of returned and subsequently reissued RBCs had the same transfusion reaction rate compared to the overall RBC transfusion reaction rate (0.5% vs. 0.5%, p = 1.0). CONCLUSION Temperature-based acceptance of returned RBCs is associated with significantly higher wastage compared to the 30-minute rule. A temperature-based acceptance practice mitigates the risk of accepting RBCs with unacceptable temperatures returned within 30 minutes of issue.
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Affiliation(s)
- Robert A DeSimone
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Michael D Nowak
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Dian T Lo
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Kathleen M Crowley
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Priscilla Parra
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Melissa M Cushing
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | - Yen-Michael S Hsu
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
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30
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DeSimone RA, Schwartz J, Schneiderman J. Extracorporeal photopheresis in pediatric patients: Practical and technical considerations. J Clin Apher 2017; 32:543-552. [DOI: 10.1002/jca.21534] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 02/06/2017] [Accepted: 02/27/2017] [Indexed: 11/10/2022]
Affiliation(s)
- Robert A. DeSimone
- Department of Pathology and Laboratory Medicine; New York-Presbyterian Hospital-Weill Cornell Medicine; New York New York
| | - Joseph Schwartz
- Department of Pathology and Cell Biology; New York-Presbyterian Hospital-Columbia University Medical Center; New York New York
| | - Jennifer Schneiderman
- Department of Pediatrics; Division of Hematology/Oncology/Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Feinberg School of Medicine, Northwestern University; Chicago Illinois
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31
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DeSimone RA, Wontakal SN, Lyashchenko AK, Schwartz J. Acute mechanical hemolysis as a complication of extracorporeal photopheresis in a low-weight child. J Clin Apher 2016; 32:571-573. [DOI: 10.1002/jca.21520] [Citation(s) in RCA: 4] [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: 08/27/2016] [Revised: 10/29/2016] [Accepted: 11/13/2016] [Indexed: 12/21/2022]
Affiliation(s)
| | | | | | - Joseph Schwartz
- New York-Presbyterian Hospital; New York New York
- Department of Pathology and Cell Biology; Columbia University Medical Center; New York New York
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32
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Shanmugam V, Geraghty B, DeSimone RA, Hoda RS. Diagnostic value of positive urinary cytology in the detection of recurrent urothelial carcinoma. Diagn Cytopathol 2016; 44:975-979. [DOI: 10.1002/dc.23598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/13/2016] [Accepted: 08/22/2016] [Indexed: 11/12/2022]
Affiliation(s)
- Vignesh Shanmugam
- Papanicolaou Cytology Laboratory, Department of Pathology & Laboratory Medicine; New York Presbyterian Hospital, Weill Cornell Medical College; New York New York
| | - Brian Geraghty
- Papanicolaou Cytology Laboratory, Department of Pathology & Laboratory Medicine; New York Presbyterian Hospital, Weill Cornell Medical College; New York New York
| | - Robert A. DeSimone
- Papanicolaou Cytology Laboratory, Department of Pathology & Laboratory Medicine; New York Presbyterian Hospital, Weill Cornell Medical College; New York New York
| | - Rana S. Hoda
- Papanicolaou Cytology Laboratory, Department of Pathology & Laboratory Medicine; New York Presbyterian Hospital, Weill Cornell Medical College; New York New York
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33
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DeSimone RA, Nellis ME, Goel R, Haas T, Vasovic L, Cushing MM. Cryoprecipitate indications and patterns of use in the pediatric intensive care unit: inappropriate transfusions and lack of standardization. Transfusion 2016; 56:1960-4. [PMID: 27185359 DOI: 10.1111/trf.13649] [Citation(s) in RCA: 8] [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: 02/10/2016] [Revised: 04/09/2016] [Accepted: 04/10/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The dosage and indications for cryoprecipitate are not well studied for any patient population. Prior observational studies have suggested that 24% to 62% of cryoprecipitate transfusions are inappropriate, and there is limited information on patterns of cryoprecipitate use in children. The purpose of this retrospective study was to explore the indications and appropriateness of the use of cryoprecipitate in critically ill children. STUDY DESIGN AND METHODS We retrospectively reviewed the electronic medical records for cryoprecipitate ordering and utilization in the pediatric intensive care unit at a large tertiary care center during a 4.5-year period. RESULTS For the 44 patients receiving cryoprecipitate, the only indication was for fibrinogen replacement and the most common clinical scenarios were recent cardiac surgery (39%) and disseminated intravascular coagulation in the setting of sepsis (32%). Cryoprecipitate was often transfused empirically at higher-than-recommended doses without a known pretransfusion fibrinogen level, and the majority (61%) of cryoprecipitate transfusions were deemed inappropriate according to our institutional guidelines. The indications selected for cryoprecipitate by providers during physician order entry matched the clinical scenario, assessed by chart and laboratory data review, in only 18% of patients. There was no significant difference in red blood cell usage in the 6-hour windows before and after cryoprecipitate transfusion. CONCLUSION Our study demonstrates a lack of standardization for the use of cryoprecipitate in critically ill children, including many inappropriate transfusions at higher-than-recommended dosing. Prospective randomized clinical trials are warranted to help determine appropriate indications and efficacious cryoprecipitate dosing in the pediatric population.
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Affiliation(s)
| | - Marianne E Nellis
- Department of Pediatrics, New York-Presbyterian Hospital, Weill Cornell Medicine, New York, New York
| | | | - Thorsten Haas
- Department of Anaesthesia, University Children's Hospital, Zurich, Switzerland
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34
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DeSimone RA, Mitsios JV, Kucine N, Goss CA, Chadburn A, Cushing MM. Transfusion medicine illustrated. Hemoglobin C after a red blood cell transfusion for sickle cell disease. Transfusion 2015; 55:2304. [PMID: 26459962 DOI: 10.1111/trf.13177] [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: 01/22/2015] [Revised: 01/31/2015] [Accepted: 04/21/2015] [Indexed: 11/27/2022]
Affiliation(s)
| | | | - Nicole Kucine
- Department of Pediatrics, Division of Hematology-Oncology, Weill Cornell Medical College, New York, New York
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35
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DeSimone RA, Hoda RS. Primary malignant melanoma of the urethra detected by urine cytology in a male patient. Diagn Cytopathol 2015; 43:680-2. [PMID: 25694368 DOI: 10.1002/dc.23258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2014] [Revised: 01/01/2015] [Accepted: 01/31/2015] [Indexed: 12/16/2023]
Affiliation(s)
- Robert A DeSimone
- Papanicolaou Cytology Laboratory, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
| | - Rana S Hoda
- Papanicolaou Cytology Laboratory, Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, New York
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36
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Weidner AS, Molina D, DeSimone RA, Cohen MA, Giorgadze T, Scognamiglio T, Hoda RS. Riedel thyroiditis: Fine needle aspiration findings of a rare entity. Diagn Cytopathol 2015; 43:747-50. [DOI: 10.1002/dc.23306] [Citation(s) in RCA: 3] [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: 01/10/2015] [Revised: 06/01/2015] [Accepted: 06/22/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Anna-Sophie Weidner
- Department of Pathology and Laboratory Medicine; Weill Cornell Medical College; New York New York
| | - David Molina
- Department of Pathology and Laboratory Medicine; Weill Cornell Medical College; New York New York
| | - Robert A. DeSimone
- Department of Pathology and Laboratory Medicine; Weill Cornell Medical College; New York New York
| | - Marc A. Cohen
- Department of Otolaryngology; Weill Cornell Medical College; New York New York
| | - Tamar Giorgadze
- Department of Pathology and Laboratory Medicine; Weill Cornell Medical College; New York New York
| | - Theresa Scognamiglio
- Department of Pathology and Laboratory Medicine; Weill Cornell Medical College; New York New York
| | - Rana S. Hoda
- Department of Pathology and Laboratory Medicine; Weill Cornell Medical College; New York New York
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37
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Coates SJ, Mitchell K, Olorunnipa OB, DeSimone RA, Otterburn DM, Simmons RM. An unusual breast lesion: granular cell tumor of the breast with extensive chest wall invasion. J Surg Oncol 2014; 110:345-7. [PMID: 24863566 DOI: 10.1002/jso.23640] [Citation(s) in RCA: 4] [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: 03/05/2014] [Accepted: 04/08/2014] [Indexed: 12/11/2022]
Abstract
Granular cell tumors (GCT) are generally benign soft tissue tumors. When located in the breast, they may be misdiagnosed as more typical tumors, such as invasive ductal carcinoma, based on misleading clinical or radiologic features. GCTs are frequently found in the setting of a known malignancy. We report the case of a patient with a large infra-mammary fold GCT, the management of which required a multidisciplinary operative approach due to extensive chest wall invasion.
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38
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Zhang T, DeSimone RA, Jiao X, Rohlf FJ, Zhu W, Gong QQ, Hunt SR, Dassopoulos T, Newberry RD, Sodergren E, Weinstock G, Robertson CE, Frank DN, Li E. Host genes related to paneth cells and xenobiotic metabolism are associated with shifts in human ileum-associated microbial composition. PLoS One 2012; 7:e30044. [PMID: 22719822 PMCID: PMC3374611 DOI: 10.1371/journal.pone.0030044] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 12/06/2011] [Indexed: 01/08/2023] Open
Abstract
The aim of this study was to integrate human clinical, genotype, mRNA microarray and 16 S rRNA sequence data collected on 84 subjects with ileal Crohn’s disease, ulcerative colitis or control patients without inflammatory bowel diseases in order to interrogate how host-microbial interactions are perturbed in inflammatory bowel diseases (IBD). Ex-vivo ileal mucosal biopsies were collected from the disease unaffected proximal margin of the ileum resected from patients who were undergoing initial intestinal surgery. Both RNA and DNA were extracted from the mucosal biopsy samples. Patients were genotyped for the three major NOD2 variants (Leufs1007, R702W, and G908R) and the ATG16L1T300A variant. Whole human genome mRNA expression profiles were generated using Agilent microarrays. Microbial composition profiles were determined by 454 pyrosequencing of the V3–V5 hypervariable region of the bacterial 16 S rRNA gene. The results of permutation based multivariate analysis of variance and covariance (MANCOVA) support the hypothesis that host mucosal Paneth cell and xenobiotic metabolism genes play an important role in host microbial interactions.
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Affiliation(s)
- Tianyi Zhang
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York, United States of America
- Department of Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Robert A. DeSimone
- Department of Medicine, Stony Brook University, Stony Brook, New York, United States of America
| | - Xiangmin Jiao
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York, United States of America
| | - F. James Rohlf
- Department of Ecology and Evolution, Stony Brook University, Stony Brook, New York, United States of America
| | - Wei Zhu
- Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, New York, United States of America
| | - Qing Qing Gong
- Department of Medicine, Washington University-St. Louis School of Medicine, Saint Louis, Missouri, United States of America
| | - Steven R. Hunt
- Department of Surgery, Washington University-St. Louis School of Medicine, Saint Louis, Missouri, United States of America
| | - Themistocles Dassopoulos
- Department of Medicine, Washington University-St. Louis School of Medicine, Saint Louis, Missouri, United States of America
| | - Rodney D. Newberry
- Department of Medicine, Washington University-St. Louis School of Medicine, Saint Louis, Missouri, United States of America
| | - Erica Sodergren
- The Genome Institute, Washington University-St. Louis School of Medicine, Saint Louis, Missouri, United States of America
| | - George Weinstock
- The Genome Institute, Washington University-St. Louis School of Medicine, Saint Louis, Missouri, United States of America
| | - Charles E. Robertson
- Department of Molecular, Cellular and Developmental Biology, University of Colorado, Boulder, Colorado, United States of America
| | - Daniel N. Frank
- Department of Medicine, University of Colorado, Aurora, Colorado, United States of America
| | - Ellen Li
- Department of Medicine, Stony Brook University, Stony Brook, New York, United States of America
- Department of Medicine, Washington University-St. Louis School of Medicine, Saint Louis, Missouri, United States of America
- * E-mail:
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