Immune checkpoint inhibitor-related thrombocytopenia (irTCP) is a relatively rare immune-related adverse event (irAE); however, overall survival may worsen when it occurs. Prolonged use of high-dose steroids can diminish the effectiveness of immune checkpoint inhibitor (ICI) therapy on the primary disease because of T lymphocyte suppression, thus early tapering is necessary. We experienced a rare case of a 79-year-old male who concurrently developed irTCP and multiple myeloma (MM) during treatment with ICIs for lung adenocarcinoma. The patient exhibited severe thrombocytopenia and elevated serum IgA levels. Based on various tests, we diagnosed MM and irTCP. Despite administering the standard bortezomib plus dexamethasone (Bd therapy) treatment for MM, there was no response and the irTCP was steroid-resistant. Consequently, we administered a regimen including daratumumab (DPd therapy) for steroid-resistant irTCP and refractory MM, which resulted in a response. As a result, we were able to avoid prolonged use of high-dose steroids and the patient is stable without exacerbation of lung adenocarcinoma for 1 year and 5 months after the onset of MM. To our knowledge, there are no cases of MM developing during ICI treatment and this is the first case report in which daratumumab was effective for the treatment of irTCP.
免疫检查点抑制剂相关血小板减少症(irTCP)是一种相对罕见的免疫相关不良事件(irAE);然而,一旦出现这种不良事件,患者的总体生存率可能会下降。长期使用大剂量类固醇会因T淋巴细胞抑制而降低免疫检查点抑制剂(ICI)治疗对原发疾病的疗效,因此必须尽早减量。我们接诊了一例罕见病例,患者是一名 79 岁的男性,在使用 ICIs 治疗肺腺癌期间同时患上了irTCP 和多发性骨髓瘤(MM)。患者表现为严重的血小板减少和血清 IgA 水平升高。根据各种检查结果,我们确诊为 MM 和 irTCP。尽管对 MM 采用了标准的硼替佐米加地塞米松(Bd疗法)治疗,但患者没有任何反应,而且irTCP对类固醇产生了耐药性。因此,我们对耐类固醇的irTCP和难治性MM采用了包括达拉土单抗(DPd疗法)在内的治疗方案,结果产生了反应。因此,我们避免了长期使用大剂量类固醇,患者在发病 1 年零 5 个月后病情稳定,肺腺癌没有恶化。据我们所知,目前还没有在 ICI 治疗期间出现 MM 的病例,这也是达拉单抗有效治疗 irTCP 的首个病例报告。
{"title":"Successful Treatment of Steroid-Refractory Immune Thrombocytopenia in a Patient Developing Multiple Myeloma While on Immune Checkpoint Inhibitor Therapy for Lung Cancer: A Case Report.","authors":"Yudai Hayashi, Masao Tsukada, Daisuke Shinoda, Marina Matsui, Kanichi Iwama, Koichi Kajiwara, Kozai Yasuji","doi":"10.2147/JBM.S468921","DOIUrl":"10.2147/JBM.S468921","url":null,"abstract":"<p><p>Immune checkpoint inhibitor-related thrombocytopenia (irTCP) is a relatively rare immune-related adverse event (irAE); however, overall survival may worsen when it occurs. Prolonged use of high-dose steroids can diminish the effectiveness of immune checkpoint inhibitor (ICI) therapy on the primary disease because of T lymphocyte suppression, thus early tapering is necessary. We experienced a rare case of a 79-year-old male who concurrently developed irTCP and multiple myeloma (MM) during treatment with ICIs for lung adenocarcinoma. The patient exhibited severe thrombocytopenia and elevated serum IgA levels. Based on various tests, we diagnosed MM and irTCP. Despite administering the standard bortezomib plus dexamethasone (Bd therapy) treatment for MM, there was no response and the irTCP was steroid-resistant. Consequently, we administered a regimen including daratumumab (DPd therapy) for steroid-resistant irTCP and refractory MM, which resulted in a response. As a result, we were able to avoid prolonged use of high-dose steroids and the patient is stable without exacerbation of lung adenocarcinoma for 1 year and 5 months after the onset of MM. To our knowledge, there are no cases of MM developing during ICI treatment and this is the first case report in which daratumumab was effective for the treatment of irTCP.</p>","PeriodicalId":15166,"journal":{"name":"Journal of Blood Medicine","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11198016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141450585","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-18eCollection Date: 2024-01-01DOI: 10.2147/JBM.S457371
Samuel Tadesse, Esayas Kebede Gudina, Daniel Yilma, Elsah Tegene Asefa, Tilahun Yemane, Andualem Mossie
Background: Numerous biomarkers are used as diagnostic, prognostic, and predictive indicators of myocardial ischemia. The most commonly used biomarkers are cardiac troponin I (Tn-I) and creatinine kinase (CK-MB). However, in developing nations, their availability in primary care settings is extremely limited. In such situations, easily available assays such as complete blood count (CBC) should be investigated as prognostic indicators in individuals with acute coronary syndrome (ACS).
Objective: This study aimed to compare the pattern of haematological indices and blood cell ratios of ACS patients compared with apparently healthy controls.
Methods: Patients diagnosed with ACS were recruited consecutively between 01 May 2022 and 31 October 2023 at Jimma Medical Center (JMC). Biochemical analyses and complete blood counts were performed. Analysis of variance was performed to compare the continuous variables. Spearman correlation coefficient tests were performed to correlate hematologic parameters with high sensitive troponin-I (hs-Tn-I) levels.
Results: This study enrolled 220 participants (110 patients with ACS and age, sex, and place of residence matched 110 non-ACS controls). From ACS group 99 (90%) were diagnosed with ST-elevated myocardial infarction. The ACS group had a significantly greater mean platelet volume (MPV), white blood cell count, red cell distribution width (RDW), neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio. The RDW (r = 0.248, p = 0.009) and MPV (r = 0.245, p = 0.009) were significantly positively correlated with hs-Tn-I levels in the ACS group. MPV, RDW, and monocyte count were significantly higher in non-survivor ACS patients (p <0.05).
Conclusion: The significant differences observed in haematological parameters between individuals with ACS and healthy controls suggest the potential utility of these easily accessible and cost-effective diagnostics in predicting future morbidity and ACS risk. Incorporating these routine evaluations into clinical practice could enhance risk assessment and improve patient outcomes.
{"title":"Haematological Indices in Acute Coronary Syndrome Patients in Ethiopia: A Comparative Cross-Sectional Study.","authors":"Samuel Tadesse, Esayas Kebede Gudina, Daniel Yilma, Elsah Tegene Asefa, Tilahun Yemane, Andualem Mossie","doi":"10.2147/JBM.S457371","DOIUrl":"10.2147/JBM.S457371","url":null,"abstract":"<p><strong>Background: </strong>Numerous biomarkers are used as diagnostic, prognostic, and predictive indicators of myocardial ischemia. The most commonly used biomarkers are cardiac troponin I (Tn-I) and creatinine kinase (CK-MB). However, in developing nations, their availability in primary care settings is extremely limited. In such situations, easily available assays such as complete blood count (CBC) should be investigated as prognostic indicators in individuals with acute coronary syndrome (ACS).</p><p><strong>Objective: </strong>This study aimed to compare the pattern of haematological indices and blood cell ratios of ACS patients compared with apparently healthy controls.</p><p><strong>Methods: </strong>Patients diagnosed with ACS were recruited consecutively between 01 May 2022 and 31 October 2023 at Jimma Medical Center (JMC). Biochemical analyses and complete blood counts were performed. Analysis of variance was performed to compare the continuous variables. Spearman correlation coefficient tests were performed to correlate hematologic parameters with high sensitive troponin-I (hs-Tn-I) levels.</p><p><strong>Results: </strong>This study enrolled 220 participants (110 patients with ACS and age, sex, and place of residence matched 110 non-ACS controls). From ACS group 99 (90%) were diagnosed with ST-elevated myocardial infarction. The ACS group had a significantly greater mean platelet volume (MPV), white blood cell count, red cell distribution width (RDW), neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio. The RDW (r = 0.248, p = 0.009) and MPV (r = 0.245, p = 0.009) were significantly positively correlated with hs-Tn-I levels in the ACS group. MPV, RDW, and monocyte count were significantly higher in non-survivor ACS patients (p <0.05).</p><p><strong>Conclusion: </strong>The significant differences observed in haematological parameters between individuals with ACS and healthy controls suggest the potential utility of these easily accessible and cost-effective diagnostics in predicting future morbidity and ACS risk. Incorporating these routine evaluations into clinical practice could enhance risk assessment and improve patient outcomes.</p>","PeriodicalId":15166,"journal":{"name":"Journal of Blood Medicine","volume":null,"pages":null},"PeriodicalIF":2.1,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11193461/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141442735","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-29eCollection Date: 2024-01-01DOI: 10.2147/JBM.S432849
Roszymah Hamzah, Ahmad Sabry Mohamad, Norafiza Mohd Yasin, Ezalia Esa, Guo Chen, Veena Selvaratnam
Background: Human hemoglobin of G-Makassar and hemoglobin E (Hb E) are hemoglobin variants that affect Beta (β) globin. Hb G-Makassar is a very rare variant while Hb E is estimated to affect at least one million people worldwide. Both Hb G-Makassar and Hb E can be inherited in the heterozygous, homozygous or compound heterozygous state. This case series describes the characteristics of four individuals with compound heterozygosity for Hb G-Makassar/Hb E cases in Malaysia. To the best of our knowledge, these are the only four individuals with this genotype reported in the literature.
Case series: We present four cases of compound heterozygosity for Hb G-Makassar/Hb E identified from October 2014 to January 2021. All the cases were incidental findings whereby the screening Hb analysis showed the presence of peaks in both Hb S and Hb E zones on capillary electrophoresis (CE) and cation-exchange high-performance liquid chromatography (HPLC). Molecular analysis confirmed the findings of compound heterozygous Hb G-Makassar/Hb E. Two cases had a history of anemia secondary to unrelated conditions that resolved with treatment of the underlying cause. The other two cases were asymptomatic individuals who were detected through Malaysia's National Thalassemia Screening program. On the last follow-up, all the individuals were well, non-transfusion dependent, and had no reported history of chronic anemia, bleeding, hemolysis or thromboembolism complications.
Conclusion: The cases reported here highlight the possibilities for rare compound heterozygous states in multi-ethnicity populations such as Malaysia. Compound heterozygous Hb G-Makassar/Hb E individuals are clinically silent with laboratory values suggesting microcytic and hypochromic red blood cells. Further local epidemiology or population studies with genotyping tests are required for a better understanding of the diversity of its clinical phenotype.
背景:人类血红蛋白 G-Makassar 和血红蛋白 E(Hb E)是影响β(β)球蛋白的血红蛋白变异体。G-Makassar 血红蛋白是一种非常罕见的变异体,而 E 血红蛋白据估计在全球至少有一百万人受到影响。Hb G-Makassar 和 Hb E 均可以杂合、同种或复合杂合状态遗传。本病例系列描述了马来西亚四名 Hb G-Makassar/Hb E 复合杂合子患者的特征。据我们所知,这是文献中仅有的四例该基因型患者:我们介绍了从 2014 年 10 月至 2021 年 1 月期间发现的四例 Hb G-Makassar/Hb E 复合杂合子病例。所有病例均为偶然发现,筛查血红蛋白分析表明,在毛细管电泳(CE)和阳离子交换高效液相色谱(HPLC)中,Hb S 区和 Hb E 区均存在峰值。分子分析证实了 Hb G-Makassar/Hb E 复合杂合子的发现。另外两例是通过马来西亚全国地中海贫血筛查计划发现的无症状患者。在最后一次随访中,所有病例均表现良好,无输血依赖,也无慢性贫血、出血、溶血或血栓栓塞并发症病史:本文报告的病例凸显了在马来西亚等多种族人群中出现罕见复合杂合子状态的可能性。复合杂合子 Hb G-Makassar/Hb E 人临床上无症状,实验室值显示为小红细胞和低色素红细胞。为了更好地了解其临床表型的多样性,需要进一步开展当地流行病学或人群基因分型测试研究。
{"title":"The Characteristics of Compound Heterozygosity for Hemoglobin G-Makassar with Hb E in Malaysia.","authors":"Roszymah Hamzah, Ahmad Sabry Mohamad, Norafiza Mohd Yasin, Ezalia Esa, Guo Chen, Veena Selvaratnam","doi":"10.2147/JBM.S432849","DOIUrl":"10.2147/JBM.S432849","url":null,"abstract":"<p><strong>Background: </strong>Human hemoglobin of G-Makassar and hemoglobin E (Hb E) are hemoglobin variants that affect Beta (β) globin. Hb G-Makassar is a very rare variant while Hb E is estimated to affect at least one million people worldwide. Both Hb G-Makassar and Hb E can be inherited in the heterozygous, homozygous or compound heterozygous state. This case series describes the characteristics of four individuals with compound heterozygosity for Hb G-Makassar/Hb E cases in Malaysia. To the best of our knowledge, these are the only four individuals with this genotype reported in the literature.</p><p><strong>Case series: </strong>We present four cases of compound heterozygosity for Hb G-Makassar/Hb E identified from October 2014 to January 2021. All the cases were incidental findings whereby the screening Hb analysis showed the presence of peaks in both Hb S and Hb E zones on capillary electrophoresis (CE) and cation-exchange high-performance liquid chromatography (HPLC). Molecular analysis confirmed the findings of compound heterozygous Hb G-Makassar/Hb E. Two cases had a history of anemia secondary to unrelated conditions that resolved with treatment of the underlying cause. The other two cases were asymptomatic individuals who were detected through Malaysia's National Thalassemia Screening program. On the last follow-up, all the individuals were well, non-transfusion dependent, and had no reported history of chronic anemia, bleeding, hemolysis or thromboembolism complications.</p><p><strong>Conclusion: </strong>The cases reported here highlight the possibilities for rare compound heterozygous states in multi-ethnicity populations such as Malaysia. Compound heterozygous Hb G-Makassar/Hb E individuals are clinically silent with laboratory values suggesting microcytic and hypochromic red blood cells. Further local epidemiology or population studies with genotyping tests are required for a better understanding of the diversity of its clinical phenotype.</p>","PeriodicalId":15166,"journal":{"name":"Journal of Blood Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11144427/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141199763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-07eCollection Date: 2024-01-01DOI: 10.2147/JBM.S457545
Xiaoyu Wang, Yingqiao Zhu, Dan Liu, Lijun Zhu, Juan Tong, Changcheng Zheng
Introduction: COVID-19 infection has brought new challenges to the treatment of adult patients with immune thrombocytopenia (ITP). In adult ITP patients, there have been no relevant reports exploring the incidence, clinical characteristics, and risk factors of platelet elevation after COVID-19 infection.
Materials and methods: A total of 66 patients with previously diagnosed ITP from December 2022 to February 2023 in a single-center were collected and analyzed for this real-world clinical retrospective observational study.
Results: In the platelet count increased group (n = 19), 13 patients (68.4%) were using thrombopoietin receptor agonists (TPO-RA) treatment at the time of COVID-19 infection; the median platelet count was 52 (2-207) ×109/L at the last visit before infection and 108 (19-453) ×109/L at the first visit after infection. In the platelet count stable group (n = 19) and platelet count decreased group (n = 28), 9 (47.4%) and 8 (28.6%) patients were using TPO-RA at the time of infection, respectively. ITP patients treated with TPO-RA had a significantly higher risk of increased platelet count than those not treated with TPO-RA at the time of infection (platelet count increased group vs platelet count decreased group: OR: 5.745, p = 0.009; platelet count increased group vs the non-increased group: OR: 3.616, p = 0.031). In the platelet count increased group, the median platelet count at 6 months post-infection was 67 (14-235) × 109/L, which was significantly higher than the platelet level at the last visit before infection (p = 0.040).
Conclusion: This study showed that some adult ITP patients had an increase in platelet count after COVID-19 infection, and this phenomenon was strongly associated with the use of TPO-RA at the time of infection. Although no thrombotic events were observed in this study, it reminds clinicians that they should be alert to the possibility of thrombotic events in the long-term management of adult ITP patients during the COVID-19 pandemic.
{"title":"Can COVID-19 Increase Platelet in Adult Immune Thrombocytopenia During the TPO-RA Administration? A Real-World Observational Study.","authors":"Xiaoyu Wang, Yingqiao Zhu, Dan Liu, Lijun Zhu, Juan Tong, Changcheng Zheng","doi":"10.2147/JBM.S457545","DOIUrl":"10.2147/JBM.S457545","url":null,"abstract":"<p><strong>Introduction: </strong>COVID-19 infection has brought new challenges to the treatment of adult patients with immune thrombocytopenia (ITP). In adult ITP patients, there have been no relevant reports exploring the incidence, clinical characteristics, and risk factors of platelet elevation after COVID-19 infection.</p><p><strong>Materials and methods: </strong>A total of 66 patients with previously diagnosed ITP from December 2022 to February 2023 in a single-center were collected and analyzed for this real-world clinical retrospective observational study.</p><p><strong>Results: </strong>In the platelet count increased group (n = 19), 13 patients (68.4%) were using thrombopoietin receptor agonists (TPO-RA) treatment at the time of COVID-19 infection; the median platelet count was 52 (2-207) ×10<sup>9</sup>/L at the last visit before infection and 108 (19-453) ×10<sup>9</sup>/L at the first visit after infection. In the platelet count stable group (n = 19) and platelet count decreased group (n = 28), 9 (47.4%) and 8 (28.6%) patients were using TPO-RA at the time of infection, respectively. ITP patients treated with TPO-RA had a significantly higher risk of increased platelet count than those not treated with TPO-RA at the time of infection (platelet count increased group vs platelet count decreased group: OR: 5.745, p = 0.009; platelet count increased group vs the non-increased group: OR: 3.616, p = 0.031). In the platelet count increased group, the median platelet count at 6 months post-infection was 67 (14-235) × 10<sup>9</sup>/L, which was significantly higher than the platelet level at the last visit before infection (p = 0.040).</p><p><strong>Conclusion: </strong>This study showed that some adult ITP patients had an increase in platelet count after COVID-19 infection, and this phenomenon was strongly associated with the use of TPO-RA at the time of infection. Although no thrombotic events were observed in this study, it reminds clinicians that they should be alert to the possibility of thrombotic events in the long-term management of adult ITP patients during the COVID-19 pandemic.</p>","PeriodicalId":15166,"journal":{"name":"Journal of Blood Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11088401/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140911208","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-05-06eCollection Date: 2024-01-01DOI: 10.2147/JBM.S455564
Salem Bahashwan, Rahaf Mohammad Almuhanna, Maryam Taher Al Hazza, Reem Wajdi Baarma, Abdulrahman Yousif AlNajjar, Faris Sameer Siddiqui, Shouq Ziyad Fatani, Ahmed Barefah, Hatem Alahwal, Abdullah Almohammadi, Osman Radhwi, Alaa S Algazzar, Eman M Mansory
Background: Sickle cell disease is an inherited blood disorder which can lead to severe complications, particularly in the cardiovascular and respiratory systems, potentially resulting in arrhythmias, pulmonary hypertension (PH), and cardiomegaly. This study aims to investigate the risk of PH and arrhythmias in adult SCD patients.
Methods: Retrospective analysis of medical records from King Abdulaziz University Hospital (KAUH) for patients with SCD aged 15 and above between 2009 and 2021. The study included 517 patients, with echocardiograms and electrocardiograms assessed according to the European Society of Cardiology/the European Respiratory Society (ESC/ERS) guidelines for categorizing PH risk (low, moderate, high) and detecting arrhythmias. Data analysis employed the Statistical Package for the Social Sciences (SPSS), utilizing quantitative and qualitative data representation. Multivariate logistic regression identified independent risk factors with odds ratios at a 95% confidence interval (CI).
Results: Among participants, 50.3% were male, with a total sample average age of 34.45 ± 9.28 years. Results indicated that 1.4% of patients experienced arrhythmias, 3.7% had a moderate PH risk, and 3.3% were classified as high PH risk. Logistic regression revealed significant independent risk factors for PH and arrhythmia in patients with SCD, with chronic kidney disease (CKD) carrying the highest odds (26.4 times higher odds of PH and 15.36 times higher odds of arrhythmias).
Conclusion: Patients with SCD are at risk for developing PH and various arrhythmias but are often underdiagnosed. Key risk factors for PH included CKD, liver cirrhosis, and pre-existing cardiac conditions. Arrhythmias were significantly associated with CKD and pre-existing cardiac conditions. To mitigate these risks, we recommend involving a multidisciplinary healthcare team in the care of adult patients with SCD. Future prospective studies are advised for early detection of PH and arrhythmias in hemoglobinopathy patients, potentially reducing mortality.
{"title":"Cardiovascular Consequences of Sickle Cell Disease.","authors":"Salem Bahashwan, Rahaf Mohammad Almuhanna, Maryam Taher Al Hazza, Reem Wajdi Baarma, Abdulrahman Yousif AlNajjar, Faris Sameer Siddiqui, Shouq Ziyad Fatani, Ahmed Barefah, Hatem Alahwal, Abdullah Almohammadi, Osman Radhwi, Alaa S Algazzar, Eman M Mansory","doi":"10.2147/JBM.S455564","DOIUrl":"10.2147/JBM.S455564","url":null,"abstract":"<p><strong>Background: </strong>Sickle cell disease is an inherited blood disorder which can lead to severe complications, particularly in the cardiovascular and respiratory systems, potentially resulting in arrhythmias, pulmonary hypertension (PH), and cardiomegaly. This study aims to investigate the risk of PH and arrhythmias in adult SCD patients.</p><p><strong>Methods: </strong>Retrospective analysis of medical records from King Abdulaziz University Hospital (KAUH) for patients with SCD aged 15 and above between 2009 and 2021. The study included 517 patients, with echocardiograms and electrocardiograms assessed according to the European Society of Cardiology/the European Respiratory Society (ESC/ERS) guidelines for categorizing PH risk (low, moderate, high) and detecting arrhythmias. Data analysis employed the Statistical Package for the Social Sciences (SPSS), utilizing quantitative and qualitative data representation. Multivariate logistic regression identified independent risk factors with odds ratios at a 95% confidence interval (CI).</p><p><strong>Results: </strong>Among participants, 50.3% were male, with a total sample average age of 34.45 ± 9.28 years. Results indicated that 1.4% of patients experienced arrhythmias, 3.7% had a moderate PH risk, and 3.3% were classified as high PH risk. Logistic regression revealed significant independent risk factors for PH and arrhythmia in patients with SCD, with chronic kidney disease (CKD) carrying the highest odds (26.4 times higher odds of PH and 15.36 times higher odds of arrhythmias).</p><p><strong>Conclusion: </strong>Patients with SCD are at risk for developing PH and various arrhythmias but are often underdiagnosed. Key risk factors for PH included CKD, liver cirrhosis, and pre-existing cardiac conditions. Arrhythmias were significantly associated with CKD and pre-existing cardiac conditions. To mitigate these risks, we recommend involving a multidisciplinary healthcare team in the care of adult patients with SCD. Future prospective studies are advised for early detection of PH and arrhythmias in hemoglobinopathy patients, potentially reducing mortality.</p>","PeriodicalId":15166,"journal":{"name":"Journal of Blood Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11086457/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140911260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
: Schizophrenia is a complex psychiatric disorder characterized by a wide array of cognitive impairments. While research has predominantly focused on the neurological aspects of schizophrenia, emerging evidence suggests that the immune system, specifically eosinophils, may play a significant role in the cognitive deficits associated with the disorder. This review presents a novel perspective on the interplay between eosinophils and cognitive impairment in schizophrenia. Eosinophils, traditionally associated with allergic responses and inflammation, have garnered limited attention within the realm of neuropsychiatry. Recent studies have hinted at a potential link between eosinophil activation and the pathogenesis of schizophrenia. In this comprehensive review, we delve into the world of eosinophils, elucidating their nature, functions, and interactions with the immune system. We examine the cognitive deficits observed in individuals with schizophrenia and discuss existing theories on the etiology of these impairments, focusing on immune system involvement. The paper also highlights the evolving body of research that supports the idea of eosinophilic influence on schizophrenia-related cognitive deficits. Furthermore, we explore potential mechanisms through which eosinophils may exert their effects on cognitive function in schizophrenia, including interactions with other immune cells and inflammatory pathways. By discussing the clinical implications and potential therapeutic avenues stemming from this newfound perspective, we underscore the practical significance of this emerging field of research. While this paper acknowledges the limitations and challenges inherent in studying eosinophils within the context of schizophrenia, it serves as a posit for novel thought in this vexing disease space as well as a call to action for future research endeavors. By providing a comprehensive survey of the existing literature and posing unanswered questions, we aim to inspire a reimagining of the relationship between eosinophils and cognitive impairment in schizophrenia, ultimately advancing our understanding and treatment of this debilitating disorder.
{"title":"Eosinophils and Cognitive Impairment in Schizophrenia: A New Perspective","authors":"E. Obeagu, Martin Bluth","doi":"10.2147/jbm.s451988","DOIUrl":"https://doi.org/10.2147/jbm.s451988","url":null,"abstract":": Schizophrenia is a complex psychiatric disorder characterized by a wide array of cognitive impairments. While research has predominantly focused on the neurological aspects of schizophrenia, emerging evidence suggests that the immune system, specifically eosinophils, may play a significant role in the cognitive deficits associated with the disorder. This review presents a novel perspective on the interplay between eosinophils and cognitive impairment in schizophrenia. Eosinophils, traditionally associated with allergic responses and inflammation, have garnered limited attention within the realm of neuropsychiatry. Recent studies have hinted at a potential link between eosinophil activation and the pathogenesis of schizophrenia. In this comprehensive review, we delve into the world of eosinophils, elucidating their nature, functions, and interactions with the immune system. We examine the cognitive deficits observed in individuals with schizophrenia and discuss existing theories on the etiology of these impairments, focusing on immune system involvement. The paper also highlights the evolving body of research that supports the idea of eosinophilic influence on schizophrenia-related cognitive deficits. Furthermore, we explore potential mechanisms through which eosinophils may exert their effects on cognitive function in schizophrenia, including interactions with other immune cells and inflammatory pathways. By discussing the clinical implications and potential therapeutic avenues stemming from this newfound perspective, we underscore the practical significance of this emerging field of research. While this paper acknowledges the limitations and challenges inherent in studying eosinophils within the context of schizophrenia, it serves as a posit for novel thought in this vexing disease space as well as a call to action for future research endeavors. By providing a comprehensive survey of the existing literature and posing unanswered questions, we aim to inspire a reimagining of the relationship between eosinophils and cognitive impairment in schizophrenia, ultimately advancing our understanding and treatment of this debilitating disorder.","PeriodicalId":15166,"journal":{"name":"Journal of Blood Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141134247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Juan-Manuel Sancho, M. Sorigué, Eva Rubio-Azpeitia
{"title":"Real-World Evidence of Relapsed/Refractory Mantle Cell Lymphoma Patients and Treatments: A Systematic Review","authors":"Juan-Manuel Sancho, M. Sorigué, Eva Rubio-Azpeitia","doi":"10.2147/jbm.s463946","DOIUrl":"https://doi.org/10.2147/jbm.s463946","url":null,"abstract":"","PeriodicalId":15166,"journal":{"name":"Journal of Blood Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141138352","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jianzhong Hu, Martin Chandler, Christopher Manuel, J. Caicedo, Michael Denne, Bruce Ewenstein, Ali G Mokdad, Shan Xing, Michael Recht
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{"title":"Risk of Intracranial Hemorrhage in Persons with Hemophilia A in the United States: Real-World Retrospective Cohort Study Using the ATHNdataset","authors":"Jianzhong Hu, Martin Chandler, Christopher Manuel, J. Caicedo, Michael Denne, Bruce Ewenstein, Ali G Mokdad, Shan Xing, Michael Recht","doi":"10.2147/jbm.s443380","DOIUrl":"https://doi.org/10.2147/jbm.s443380","url":null,"abstract":"of","PeriodicalId":15166,"journal":{"name":"Journal of Blood Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140775646","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Bazarbashi, Heba El Zawahry, T. Owaidah, Mohammad AlBader, Ashraf Warsi, Mahmoud Marashi, Emad Dawoud, Hassan Jaafar, Sherif Sholkamy, Fady Haddad, Alexander T Cohen
: Venous thromboembolism is a leading cause of morbidity and mortality in patients with active cancer who require anticoagulation treatment. Choice of anticoagulant is based on careful balancing of the risks and benefits of available classes of treatment: vitamin K antagonists, low-molecular-weight heparin (LMWH), and direct oral anticoagulants (DOACs). Results from randomized controlled trials have shown the consistent efficacy of DOACs versus LMWH in the treatment of cancer-associated venous thromboembolism (VTE). However, increased major gastrointestinal bleeding was observed for edoxaban and rivaroxaban, but not apixaban, compared with LMWH dalteparin. Most guidelines recommend DOACs for the treatment of cancer-associated VTE in patients without gastrointestinal or genitourinary cancer, and with considerations for renal impairment and drug–drug interactions. These updates represent a major paradigm shift for clinicians in the Middle East and North Africa. The decision to prescribe a DOAC for a patient with cancer is not always straightforward, particularly in challenging subgroups of patients with an increased risk of bleeding. In patients with gastrointestinal malignancies who are at high risk of major gastrointestinal bleeds, apixaban may be the preferred DOAC; however, caution should be exercised if patients have upper or unresected lower gastrointestinal tumors. In patients with gastrointestinal malignancies and upper or unresected lower gastrointestinal tumors, LMWH may be preferred. Vitamin K antagonists should be used only when DOACs and LMWH are unavailable or unsuitable. In this review, we discuss the overall evidence for DOACs in the treatment of cancer-associated VTE and provide treatment suggestions for challenging subgroups of patients with cancer associated VTE.
{"title":"The Role of Direct Oral Anticoagulants in the Treatment of Cancer-Associated Venous Thromboembolism: Review by Middle East and North African Experts","authors":"S. Bazarbashi, Heba El Zawahry, T. Owaidah, Mohammad AlBader, Ashraf Warsi, Mahmoud Marashi, Emad Dawoud, Hassan Jaafar, Sherif Sholkamy, Fady Haddad, Alexander T Cohen","doi":"10.2147/jbm.s411520","DOIUrl":"https://doi.org/10.2147/jbm.s411520","url":null,"abstract":": Venous thromboembolism is a leading cause of morbidity and mortality in patients with active cancer who require anticoagulation treatment. Choice of anticoagulant is based on careful balancing of the risks and benefits of available classes of treatment: vitamin K antagonists, low-molecular-weight heparin (LMWH), and direct oral anticoagulants (DOACs). Results from randomized controlled trials have shown the consistent efficacy of DOACs versus LMWH in the treatment of cancer-associated venous thromboembolism (VTE). However, increased major gastrointestinal bleeding was observed for edoxaban and rivaroxaban, but not apixaban, compared with LMWH dalteparin. Most guidelines recommend DOACs for the treatment of cancer-associated VTE in patients without gastrointestinal or genitourinary cancer, and with considerations for renal impairment and drug–drug interactions. These updates represent a major paradigm shift for clinicians in the Middle East and North Africa. The decision to prescribe a DOAC for a patient with cancer is not always straightforward, particularly in challenging subgroups of patients with an increased risk of bleeding. In patients with gastrointestinal malignancies who are at high risk of major gastrointestinal bleeds, apixaban may be the preferred DOAC; however, caution should be exercised if patients have upper or unresected lower gastrointestinal tumors. In patients with gastrointestinal malignancies and upper or unresected lower gastrointestinal tumors, LMWH may be preferred. Vitamin K antagonists should be used only when DOACs and LMWH are unavailable or unsuitable. In this review, we discuss the overall evidence for DOACs in the treatment of cancer-associated VTE and provide treatment suggestions for challenging subgroups of patients with cancer associated VTE.","PeriodicalId":15166,"journal":{"name":"Journal of Blood Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140766501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-03-20eCollection Date: 2024-01-01DOI: 10.2147/JBM.S442134
Gordon M Riha, Alyssa Johnson, Sadie Arnold, Michael S Englehart, Simon J Thompson
Purpose: The state of Montana encompasses and defines rural health care as it is known in the United States (US) today. This vast area is punctuated by pockets of health care availability with varying access to blood products for transfusion. Furthermore, timely transport is frequently challenged by weather that may limit air transportation options, resulting in multiple hours in ground transport to definitive care.
Patients and methods: The Montana State Trauma Care Committee (MT-STCC) developed the Montana Interfacility Blood Network (MT-IBN) to ensure blood availability in geographically distanced cases where patients may otherwise not survive. The index case that led to the formal development of the MT-IBN is described, followed by a second case illustrating the IBN process.
Results: This process and development manuscript details the innovative efforts of MT-STCC to develop this fledgling idea unique to rural US health care. We review guidelines that have been developed to define broad aspects of the MT-IBN including the reason to share resources, proper packaging, paperwork necessary for transfer, and how to provide resources directly to the patient. Finally, we describe implementation within the state.
Conclusion: The MT-IBN was developed by MT-STCC to facilitate the hand-off of lifesaving blood to patients being transported by ground to definitive care in Montana without having to stop at an intermediary facility. This has already led to lives saved in areas that are limited in blood availability due to rurality.
目的:蒙大拿州涵盖并定义了当今美国的农村医疗保健。在这片广袤的土地上,各地的医疗服务设施不尽相同,但获得输血用血液制品的途径却各不相同。此外,及时转运经常受到天气的影响,因为天气可能会限制空中运输的选择,导致地面运输需要多个小时才能到达最终医疗机构:蒙大拿州创伤救护委员会(Montana State Trauma Care Committee,MT-STCC)建立了蒙大拿设施间血液网络(Montana Interfacility Blood Network,MT-IBN),以确保在地理位置偏远的病例中血液的供应,否则患者可能无法存活。本文介绍了促使蒙大拿州医疗机构间血液网络正式发展的病例,并通过第二个病例说明了医疗机构间血液网络的发展过程:本过程与开发手稿详细介绍了 MT-STCC 为开发这一美国农村医疗保健领域独有的新兴理念所做的创新努力。我们回顾了为确定 MT-IBN 的广泛方面而制定的指导方针,包括共享资源的原因、适当包装、转移所需的文书工作以及如何直接向患者提供资源。最后,我们介绍了该州的实施情况:MT-IBN 是由 MT-STCC 研发的,旨在为蒙大拿州通过陆路转运到最终医疗机构的患者提供救生血液,而无需在中间设施停留。这已经在一些因偏远而血液供应有限的地区挽救了生命。
{"title":"The Montana Interfacility Blood Network: A Novel Lifesaving \"Hand-off\" for the Optimal Care of Rural Patients.","authors":"Gordon M Riha, Alyssa Johnson, Sadie Arnold, Michael S Englehart, Simon J Thompson","doi":"10.2147/JBM.S442134","DOIUrl":"10.2147/JBM.S442134","url":null,"abstract":"<p><strong>Purpose: </strong>The state of Montana encompasses and defines rural health care as it is known in the United States (US) today. This vast area is punctuated by pockets of health care availability with varying access to blood products for transfusion. Furthermore, timely transport is frequently challenged by weather that may limit air transportation options, resulting in multiple hours in ground transport to definitive care.</p><p><strong>Patients and methods: </strong>The Montana State Trauma Care Committee (MT-STCC) developed the Montana Interfacility Blood Network (MT-IBN) to ensure blood availability in geographically distanced cases where patients may otherwise not survive. The index case that led to the formal development of the MT-IBN is described, followed by a second case illustrating the IBN process.</p><p><strong>Results: </strong>This process and development manuscript details the innovative efforts of MT-STCC to develop this fledgling idea unique to rural US health care. We review guidelines that have been developed to define broad aspects of the MT-IBN including the reason to share resources, proper packaging, paperwork necessary for transfer, and how to provide resources directly to the patient. Finally, we describe implementation within the state.</p><p><strong>Conclusion: </strong>The MT-IBN was developed by MT-STCC to facilitate the hand-off of lifesaving blood to patients being transported by ground to definitive care in Montana without having to stop at an intermediary facility. This has already led to lives saved in areas that are limited in blood availability due to rurality.</p>","PeriodicalId":15166,"journal":{"name":"Journal of Blood Medicine","volume":null,"pages":null},"PeriodicalIF":2.0,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10961070/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140206896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}