中国实验血液学杂志最新文献

Objective: To explore the laboratory diagnosis of neonatal alloimmune thrombocytopenia (NAIT) caused by anti-HLA antibodies and analyze the clinical data of affected newborns.

Methods: The platelet antibodies, HLA genotyping, and HPA-1~5, -15 genotyping of 5 newborns with thrombocytopenia and their parents were determined by flow cytometry, ELISA, Monoclonal antibody specific immobilization of platelet antigens (MAIPA), Sanger sequencing technology, and matrix-assisted laser desorption ionization-time or flight mass spectrometry(MALDI-TOF MS), respectively. Additionally, these 5 cases were summarized with 17 similar cases reported in the literature to analyze the impact of NAIT mothers' pregnancy history and anti-HLA antibody types on platelet counts of newborns.

Results: Antibodies against the HLA antigen of the children's father were detected in plasma of the 5 mothers. The mother of Case 1 had anti-HLA-A29 and anti-HLA-B7 antibodies, and her newborn had anti-HLA-B7 antibody, HLA genotype was A*02:07,29:01; B*07:05,46:01; the mother of Case 2 had anti-HLA-B51 antibody, and the newborn had anti-HLA-B78 antibody, HLA genotype was A*11:01,11:01; B*38:02,51: 01; the mother of Case 3 had anti-HLA-B60 antibody, and her newborn's HLA genotype was A*02:07,11:01; B*39:15,40:01; the mother of Case 4 had anti-HLA-A11 antibody, and the newborn's HLA genotype was A*11:01,29:01; B*07:05,13:01; the mother of Case 5 had anti-HLA-A203 and anti-HLA-B60 antibodies, and the newborn had anti-HLA-A203 antibody, HLA genotype was A*02:03,11:01; B*39:15,40:01. Cases 2 and 3 showed compatible in HPA-1~5, -15 genotyping between the newborn and their mothers; the newborn of case 1 had HPA-2 and HPA-3 incompatibility with their mother; the newborn of Case 4 and Case 5 had HPA-15 and HPA-2 incompatibility with their mother, respectively. The HPA antibody was excluded by MAIPA technique. Among the 22 cases of anti-HLA antibodies induced NAIT, the platelet count of the newborns born to mothers with their first pregnancy was significantly lower than that of newborna born to mothers multiple gregnancies (P <0.01). Newborns whose mothers had both anti-HLA-A and anti-HLA-B antibodies had lower platelet counts than those with only one type of antibody (P <0.01).

Conclusion: The identification of anti-HLA and HPA antibodies, genotyping are important for the diagnosis of NAIT. Newborns who are pregnant for the first time and whose mothers have multiple HLA antibody types simultaneously may face a higher risk of bleeding and require close monitoring as well as prompt treatment.

Objective: To investigate the prognostic value of prognostic nutritional index (PNI) and lymphocyte-to-monocyte ratio (LMR) in patients with follicular lymphoma (FL).

Methods: The baseline clinical data of 120 newly diagnosed FL patients admitted to the Department of Hematology of the Affiliated Hospital of Xuzhou Medical University from February 2014 to May 2023 were analyzed retrospectively. The optimal cutoff values of PNI, LMR and neutrophil-to-lymphocyte ratio (NLR) were determined by receiver operating characteristic (ROC) curve analysis. Cox proportional hazards model was used for univariate and multivariate analyses. Kaplan-Meier method was used for survival analysis, and log-rank test was adopted for intergroup comparison.

Results: The optimal cutoff values of PNI, LMR and NLR were 47.35, 3.46 and 2.59, respectively. The results of the χ² test showed that Eastern Cooperative Oncology Group performance status (ECOG PS) score≥2, the long diameter of the largest lymph node > 6 cm, histological grade 3, elevated lactate dehydrogenase (LDH), high risk score of the follicular lymphoma international prognostic index (FLIPI), low PNI, low LMR and high NLR were significantly correlated with the increased risk of progression of disease within 24 months (POD24) (P < 0.05). The results of univariate analysis showed that age≥60 years old, male, ECOG PS score≥2, the long diameter of the largest lymph node > 6 cm, hemoglobin (Hb) < 120 g/L, elevated LDH, low PNI, low LMR, high NLR, high-density lipoprotein cholesterol (HDL-C) < 40 mg/dl, and high-risk scores of FLIPI and FLIPI2 were associated with poor progression-free survival (PFS) and overall survival (OS) in FL patients (P < 0.05). The results of multivariate analysis showed that low PNI and low LMR were independent risk factors affecting the OS in FL patients, and low PNI was also an independent risk factor affecting the PFS of FL patients. The use of anti-CD20 monoclonal antibody in first-line treatment and maintenance therapy could improve the remission rate, showing benefits for PFS and OS. In addition, integrating PNI and LMR into FLIPI and FLIPI2 scores was helpful to better predict the PFS and OS of patients in different risk groups.

Conclusions: PNI and LMR are independent prognostic factors for FL patients, and the composite biomarker composed of PNI, LMR and FLIPI or FLIPI2 demonstrated enhanced accuracy in predicting prognosis for FL patients.

Objective: Through the screening of serum and urine M protein in the health examination population in Daqing area, the prevalence rate, age/gender distribution characteristics and subtype composition of monoclonal gammopathy of undetermined significance (MGUS) were clarified, providing baseline data for the early screening of plasma cell diseases in Northeast China.

Methods: A prospective observational study design was adopted, 1137 healthy individuals aged 30 and above (715 males and 422 females) in Daqing City Examination Center between July and September 2023 were included in this study. Screening for M protein was initially conducted through serum protein electrophoresis (SPE) and urine protein electrophoresis, and positive samples were confirmed by serum or urine immunofixation electrophoresis (IFE) for MGUS. Statistical analysis was performed using the Cochran-Armitage trend test, Fisher's exact test, and multivariate logistic regression analysis.

Results: Among 1137 healthy individuals aged 30 and above, 18 cases of MGUS were diagnosed, with a total prevalence of 1.58% (18/1137). The prevalence of MGUS in those over 40 years old was 1.66% (15/903). The prevalence of MGUS significantly increased with age (P=0.003). There was no significant difference in prevalence between males and females (1.68%vs. 1.42%, P=0.811). The subtype distribution of MGUS was dominated by IgG type, accounting for 77.78% (14/18), followed by IgA type at 16.67% (3/18), and light chain type at 5.56% (1/18). No IgM type or biclonal type was detected. Age ≥60 years was an independent risk factor for MGUS (adjusted or=4.37, 95%CI: 1.42-13.45, P=0.010).

Conclusion: The prevalence of MGUS in Daqing area is approximately 1.58%, with no gender difference and a positive correlation with age. The predominant subtype is IgG type.

Objective: To explore the effect of body mass index (BMI) on the efficiency of hematopoietic stem cell (HSC) mobilization.

Methods: A retrospective analysis was conducted on the clinical data of 158 healthy donors who underwent peripheral blood HSC mobilization in the Affiliated Hospital of Xuzhou Medical University from January 2011 to September 2022. According to the BMI Chinese standard, donors were divided into three groups: normal weight group (BMI<24), overweight group (24≤BMI<28) and obesity group (BMI≥28). The differences in peripheral blood white blood cell (WBC) count, neutrophil count, increase ratios, and peak times obtained from dynamical monitoring between different BMI groups were compared, as well as the differences in mononuclear cell (MNC) count and CD34⁺ cell count in different age, sex and BMI groups.

Results: The median age of 158 donors was 36(18-65) years, with 102 males and 56 females. Donors aged 18-39, 40-49, 50-59 and ≥60 years accounted for 68.4%, 24.1%, 6.3% and 1.3%, respectively. The normal weight, overweight and obesity groups had 68, 56 and 34 cases, respectively. Before collection, the peak WBC count in the normal weight, overweight and obesity groups were 51.30(21.60-84.30)×10⁹/L, 50.30(20.30-85.90)×10⁹/L, and 50.30(24.89-67.80)×10⁹/L, respectively. There was no significant difference between the three groups (P>0.05). The peak neutrophil count in the three groups were 42.59(18.77-76.62)×10⁹/L, 43.74(16.85-72.75)×10⁹/L, and 42.84(17.88-54.73)×10⁹/L, respectively. There was no significant difference between the three groups (P>0.05). The number of MNCs collected in the three groups was 8.55(3.50-19.30)×10⁸/kg, 9.15(3.73-26.20)×10⁸/kg, and 9.79(4.14-30.90)×10⁸/kg, respectively. There was no significant difference between the three groups (P>0.05). The number of CD34⁺ cells collected in the three groups was 4.56(1.44-11.47)×10⁶/kg, 4.66(1.48-13.48)×10⁶/kg, and 5.27(2.27-12.60)×10⁶/kg, respectively. There was no significant difference between the three groups (P>0.05).

Conclusion: BMI has no significant effect on the mobilization efficiency of peripheral blood HSCs in healthy donors.

Objective: To explore the characteristics of voluntary blood donors with direct antiglobulin test (DAT) positivity and the impact of DAT positivity on blood quality, and to propose a management strategy for these donors.

Methods: A retrospective analysis was performed on the relevant data of 80 DAT-positive blood donors from 2020 to 2023, including sex, age, ABO blood group, and blood quality sampling results. Additionally, antibody typing, agglutination strength, and DAT follow-up results from subsequent blood donations were analyzed.

Results: Among DAT-positive blood donors, age was positively correlated with the DAT positivity rate (r =0.8545), while there were no statistically significant differences in DAT positivity rates among donors of different sex and blood groups. IgG antibody was predominant (67.50%), with agglutination strength primarily between 1+ and 2+. There were no statistically significant differences in some blood quality sampling items between DAT-positive and DAT-negative donors (P >0.05). Follow-up results showed that 93.02% of DAT-positive donors had negative DAT results during subsequent donations.

Conclusion: The positivity rate of DAT among blood donors is positively correlated with age. It is recommended to conduct follow-up testing on DAT-positive donors. For rejected DAT-positive blood units, quality sampling tests can be performed to conserve blood resources.

Objective: To analyze the distribution trends of irregular erythrocyte antibodies among hospitalized patients in Shenzhen Hospital of Southern Medical University from 2020 to 2024, and to evaluate the impact of Rh-compatible transfusion strategies on antibody profiles, thereby providing evidence for optimizing antigen compatibility protocols.

Methods: A retrospective study was conducted using data from the Transfusion Laboratory Information Management System (TLIS). Irregular antibody screening and specificity identification were performed using automated microcolumn gel agglutination and manual methods.

Results: The overall positive rate of irregular antibodies was 0.76% (309/40 646). The proportion of Rh blood group system antibodies significantly decreased from 56.36% (2020) to 21.05% (2024), while MNS system antibodies increased from 7.27% (4/55) to 25.00% (19/76), surpassing Rh antibodies for the first time in 2024. Lewis system antibodies also showed a notable rise (7.77% overall).

Conclusion: Rh-compatible transfusion effectively reduces Rh-related immunization but shifts antibody burden to MNS and Lewis systems. Regional transfusion protocols should prioritize MNS and Lewis antigen matching, with enhanced screening for Kidd antibodies in high-risk populations.

Patients with myeloproliferative neoplasms (MPNs) are at risk of developing solid tumors. Although the connection between MPN and solid tumors has been widely discussed, the cause remains to be explored. Some studies show that the MPN is considered to trigger a second cancer, but others suggest both diseases seem to share the same origin. In recent years, more and more studies have found that genetic susceptibility, drugs, chronic inflammation, immune function abnormalities and clonal hematopoiesis of indeterminate potential are related to the development of second cancers. In this review, we try to summarize the new advances of biological characteristics and pathogenesis of second cancers in MPNs.

There is a complex biological mechanism in the phosphatidylinositol-3-kinase (PI3K)/protein kinase B (PKB/Akt)/mammalian target of rapamycin (mTOR) signaling pathway, which plays a key role in the development and development of lymphoma. In this review, the relevant literature of PI3K inhibitor research in the past five years summarized and analyzed, and found that the research and development, application, efficacy, and adverse reactions of PI3K inhibitors are the current research hotspots, and the positive results of PI3K inhibitors in clinical trials and basic research have strongly demonstrated the potential of PI3K inhibitors in personalized treatment of lymphoma. In order to maximize the clinical benefits, a variety of strategies need to be explored, including novel drugs with better selectivity and safety, and related combination therapies.

Objective: To detect the serum levels of 25(OH)D, miR-125b-5p, hypoxia-inducible factor-1α (HIF-1α) and vascular endothelial growth factor A (VEGFA) in patients with multiple myeloma (MM), and explore the role of miR-125b-5p/HIF-1α pathway in the involvement of vitamin D deficiency in the pathogenesis of MM.

Methods: Fifty three newly diagnosed/relapsed MM patients admitted to the department of hematology of our hospital from October 2021 to December 2023 were included. Meanwhile, 25 healthy individuals matched in gender and age from our hospital's Health Management Center were selected as controls. The serum level of 25(OH)D was monitored by mass spectrometry, the serum level of miR-125b-5p was detected by real-time fluorescence quantitative PCR, and serum levels of HIF-1α and VEGFA were measured by enzyme-linked immunosorbent assay. The levels of 25(OH)D, miR-125b-5p, HIF-1α, and VEGFA were compared between the two groups. According to the level of 25(OH)D, the MM patients were divided into vitamin D deficiency group (< 20 ng/ml) and vitamin D non-deficiency group (≥20 ng/ml), and the levels of miR-125b-5p, HIF-1α, and VEGFA were compared between the two groups. The correlations between 25(OH)D, miR-125b-5p, HIF-1α and VEGFA were analyzed. The receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic value of 25(OH)D combined with miR-125b-5p for newly diagnosed MM.

Results: The level of 25(OH)D in MM patients was significantly lower than that in control group (P < 0.01). There was no significant difference in 25(OH)D level between newly diagnosed and relapsed MM patients (P >0.05). Compared with the control group, the level of miR-125b-5p was significantly reduced in MM patients (P < 0.01), while the levels of HIF-1α and VEGFA were significantly increased (both P < 0.001). In MM patients, the miR-125b-5p level in the vitamin D deficiency group was significantly decreased than that in the non-deficiency group (P < 0.01), while the levels of HIF-1α and VEGFA were significantly increased (both P < 0.05). In MM patients, 25(OH)D was positively correlated with miR-125b-5p, while negatively correlated with HIF-1α and VEGFA (both P < 0.05). Moreover, miR-125b-5p was negatively correlated with HIF-1α and VEGFA (both P < 0.05). The area under the curve (AUC) for diagnosing MM with 25(OH)D, miR-125b-5p, and their combination were 0.699, 0.751, and 0.791, respectively.

Conclusion: The incidence of vitamin D deficiency is high in MM patients. Vitamin D deficiency may promote angiogenesis and participate in the occurrence and development of MM by downregulating miR-125b-5p and upregulating HIF-1α and VEGFA expression.