Blood Transfusion最新文献

Background: Chronic graft-vs-host disease (cGvHD) is a severe immune-mediated complication that affects patients following allogeneic hematopoietic stem cell transplantation (allo-HSCT). Oral manifestations of cGvHD, such as ulcers and mucosal inflammation, significantly impair quality of life and often require long-term treatment. Existing therapies provide limited relief, prompting the exploration of new approaches, including the use of autologous platelet lysate (PL) gel for its regenerative properties.

Materials and methods: This observational study evaluated the effectiveness and safety of a topical autologous PL gel in treating oral ulcers associated with cGvHD in seven patients who had undergone allo-HSCT for hematological malignancies. The PL gel was prepared by mixing autologous PL with a gel base under aseptic conditions, and patients applied the gel three times daily. Clinical assessments, including the severity of oral damage and pain levels, were conducted using the NIH-CTCAE scale.

Results: Of the seven patients treated, five completed the study with a median follow-up of 20 months. Significant reductions in oral damage severity and pain levels were observed, with a p-value of 0.0495 for symptom severity and 0.0196 for pain reduction. The average adherence rate was 81.4%, and no adverse effects were reported.

Discussion: The study demonstrated that autologous PL gel is a promising and well-tolerated treatment for oral manifestations of cGvHD, offering significant symptom relief. Despite the small sample size, these findings align with previous studies and support further research into PL gel as a therapeutic option in cGvHD management.

Background: Although topical corticosteroids (TCS) represent first-line treatment for vulvar lichen sclerosus (VLS) and as such should be prescribed to all women at time of diagnosis, approximately 30% of patients do not experience complete symptom resolution following such treatment. TCS may not effectively improve vulvar trophism and elasticity, both of which are crucial for sexual function. Owing to its regenerative and healing properties, cord blood platelet-rich plasma (CB-PRP) may represent an efficacious supplementary therapy, to be administered following first line treatment with TCS. The primary aim of this study was to assess safety and tolerability of CB-PRP in women with VLS.

Materials and methods: This is a pilot study which precedes a randomized controlled trial of CB-PRP vs placebo in women with VLS. Ten consecutive patients with VLS, who had previously undergone standard TCS-treatment, received three vulvar CB-PRP injections monthly. Follow-up was conducted three months after the last injection using vulvoscopy and validated questionnaires to evaluate safety and tolerability, as well as patient satisfaction, symptom improvement, sexual function, psychological well-being, quality of life, frequency of TCS application as a maintenance treatment, vulvar trophism and architectural modifications.

Results: No adverse clinical effects were observed. Five patients (50%) were either satisfied or very satisfied with the procedure, four (40%) were uncertain about their satisfaction with the treatment. One patient (10%) dropped out for personal reasons and was classified as unsatisfied according to an intention-to-treat analysis. At follow-up median numeric rating scale scores were significantly reduced for vulvar burning compared to baseline (p<0.05) there was a trend toward improvement in itching, dyspareunia, and dysuria. A significant improvement in sexual arousal and satisfaction was observed in all treated women (p<0.05).

Discussion: CB-PRP may be a promising treatment for VLS. It appears to be safe and improve symptoms and sexual function.

Background: Acute myeloid leukemia (AML) is characterized by high heterogeneity, poor long-term survival, and a propensity for relapse. Exceptional efficacy in treating recurrent or refractory B-lymphoid malignancies has been demonstrated by Chimeric antigen receptor T cells (CAR-T cells). Given the therapeutic potential of targeting both CD33 and C-type lectin-like molecule-1 (CLL1) in AML, the development of a dual-targeting CD33-CLL1 CAR-T cells assumes significant importance.

Materials and methods: The expressions of CD33 and CLL-1 antigens in peripheral blood cells and bone marrow cells from AML patients was assessed. Subsequently, a Chimeric Antigen Receptor (CAR) incorporating a dual-specific single-chain variable fragment targeting CLL1 and CD33 (CD33-CLL1-CAR-T) was engineered. The anti-tumor efficacy and potential side effects of CD33-CLL1-CAR-T cells were comprehensively investigated in both in vitro and in vivo settings.

Results: The constructed tandem CD33-CLL1 CAR-T exhibited potent cytotoxicity against leukemia cell lines and human primary AML cells in vitro. Co-cultivation of AML blasts with CD33-CLL1-CAR-T cells resulted in effective proliferation and the secretion of substantial quantities of GM-CSF and IFN-γ. Importantly, the impact of CD33-CLL1-CAR-T cells on normal hematopoietic stem cells was minimal, ensuring safety in vivo mouse models. Notably, significant anti-leukemic activity was observed in the mouse model, with CD33-CLL1-CAR-T cells leading to tumor eradication and prolonged survival.

Discussion: The tandem CD33-CLL1 CAR-T cells not only efficiently eliminated AML blasts but also exhibited low cytotoxicity toward normal hematopoietic stem cells (HSCs). These findings underscore the potential clinical applicability of the tandem CD33-CLL1 CAR-T cells as an effective and safe treatment strategy for AML, representing a noteworthy advancement in the field of CAR-T cells therapy.

Background: Evans syndrome is a rare autoimmune disease characterized by simultaneous or sequential primary immune thrombocytopenia and autoimmune hemolytic anemia. Despite the low incidence of Evans syndrome after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, its progression may threaten public health. This review offers an up-to-date summary of the works on the association between coronavirus disease 2019 (COVID-19) and Evans syndrome to explore the pathogenic mechanisms, epidemiological characteristics, clinical presentations, diagnostic markers, and treatment strategies.

Material and methods: We searched PubMed and Web of Science to identify articles that explored the relationship between COVID-19 and Evans syndrome. We collected and organized all reported cases of Evans syndrome following COVID-19 or SARS-CoV-2 vaccination over the past 4 years and also expanded the search to examine other cases of post-infection Evans syndrome.

Results: Thirteen cases were included with an average age of 42 years of whom 12 survived and one died. Two cases were associated with pregnancy and four with vaccination, two involved epileptic seizures, and three had a history of autoimmune disease.

Discussion: Patients with Evans syndrome and exposure to SARS-CoV-2 have a potential risk of bleeding. This risk should prompt close monitoring of bleeding biomarker dynamics and early initiation of hemostatic treatments, including platelet transfusion, corticosteroids, thrombopoietin receptor agonists, intravenous immunoglobulin and rituximab.

Discussion: The present study highlights the highly heterogeneous criteria for the use of PAD (including calculating of the volume of whole blood collected) and the lack of a specific policy in preparation for BM HSC donation, either from non-trait carrier donors or those with sickle cell or thalassemia trait, both pediatric and adolescent.

Background: Current national and international guidelines (Italian Bone Marrow Donor Registry [IBMDR], World Marrow Donor Association [WMDA] standards) provide an indication for preoperative autologous blood donation (PAD) only in adult family and volunteer non-family donors in anticipation of bone marrow (BM) hematopoietic stem cell (HSC) donation to avoid the use of homologous transfusions. In addition, there is no clear guidance from the relevant scientific societies regarding pediatric and adolescent donors.

Material and methods: To assess the actual use of PAD in pediatric (up to 14 years) and adolescent (aged 15-18 years) family donors in relation to BM HSC donation in the five years 2017-2021, a specific online questionnaire was administered to blood establishments and clinical units of pediatric transplantation programs responsible for BM HSC collection.

Results: Adherence to the project was 100% (18/18 centers). During the five-year period considered, 273 BM HSC donors (205 pediatric and 68 adolescent) were registered. Forty percent of the non-trait carrier donors who underwent PAD received iron therapy in preparation for BM HSC donation; only 4.8% of the pediatric and none of the adolescents had hemoglobin values below the age limit at donation. Finally, 66.4% of pediatric donors and 15.4% of non-trait carrier adolescent donors who did not undergo PAD received homologous transfusions during BM harvest.

Background: Blood transfusion is a life-saving intervention for many species of veterinary interest, including sheep. Despite extensive research on the impact of refrigerated storage of packed red blood cells (pRBC) in humans, research on the quality of stored ovine blood is limited and storage guidelines are mostly informed by studies in humans. Human pRBC are currently stored without residual white blood cells, following selective removal of the leukocytes by filtration (leukoreduction). This process delays the onset and mitigates the progression of the storage lesion, a series of molecular changes that RBC undergo as a function of storage duration. However, leukoreduction of ovine pRBC is not routinely performed.

Materials and methods: Here we performed metabolomics analyses of non-leukoreduced (nLR) and LR pRBC from six sheep. Units were stored under standard veterinary blood bank conditions (4°C) for up to 42 days and sterilely sampled weekly for metabolomics analyses of cells and supernatants.

Results: LR-pRBC showed significantly lower levels of mono-, di- and tri-carboxylates in both the cellular and supernatant compartments, and slower accumulation of lactate and immunomodulatory succinate, fumarate and malate. The presence of residual white blood cells in the units accelerated the consumption of glucose from the media, with no increase in detectable high energy phosphate compounds (AMP). nLR showed a higher degree of purine breakdown and deamination products, (hypoxanthine, xanthine and allantoate). Elevated free fatty acids in nLR RBC are consistent with increased lipid peroxidation and lipolysis. Strong sex dimorphism was observed across all samples, independently of storage duration or leukoreduction.

Discussion: Leukoreduction of ovine pRBC delays the onset and mitigates the metabolic storage lesion to central energy and redox metabolism, while almost completely abrogating the accumulation of carboxylates in stored units.

Background: Despite fulfilling all requirements for donor blood units as defined by the FDA, a number of patients with sickle cell disease (SCD) are transfused with red blood cell (RBC) units that are near the end of their storage life, exposing them to the potentially adverse components of the red cell storage lesion. Due to their chronically inflamed state, patients with SCD may be particularly susceptible to these components. We present here a pilot study protocol for testing the impact of fresh vs older red cell units in chronically transfused adults with SCD.

Materials and methods: This is a randomized, prospective, clinical trial. We aimed to recruit forty chronically transfused adults or adolescents with SCD who receive regular RBC transfusions for their clinical care and randomize these patients to receive either units greater than or equal to 30 days, or units less than or equal to 10 days for 3 consecutive outpatient transfusion events.

Results: The primary endpoint is the metabolic differences identified between units transfused that are greater than or equal to 30 days, and those units less than or equal to 10 days. The secondary endpoint evaluates the change in blood monocyte activation at 2 hours after transfusion between the two groups. Lastly, we evaluate unit RBC efficacy via changes in hemoglobin/day, hemoglobin A%/day, hospitalization rate, pain scores, and infections as documented via blood and urine cultures.

Discussion: This study promises to provide evidence as to whether metabolically older red cell units affect the quality and efficacy of chronic transfusion therapy for adults with SCD and has the potential to guide the need for future study on this important clinical issue.

Background: Obstetric hemorrhage is a life-threatening complication of pregnancy. Systematic collection of data on transfusion practice during pregnancy and post-partum period are scarce, as well as data on fetal or neonatal outcomes of women transfused during pregnancy.We examined the prevalence of obstetric hemorrhage and outcome of pregnancies in hospitalized transfused women.

Materials and methods: This is a retrospective cohort study collecting clinical and laboratory data of women transfused from 2015 to 2017 in three Italian Tertiary level Obstetrical Departments. Inclusion criteria were: 1) age >18 years; 2) antepartum or peripartum hospital admission and 3) transfusion during the hospital stay of at least one unit of packed red blood cell (RBC) units. Women below 18 years and/or with transfusion outside pregnancy were excluded.During the observation period, 18,495 women gave birth across the three Obstetrics Departments: transfusion rate was 1.7%.

Results: 315 women were included in the final analysis. Most (75.2%) needed transfusion from 35 weeks onwards. A percentage higher that that observed in general population of transfused women showed co-morbidities such as hypertensive disorders or diabetes (13.9 vs 5.5%). We recorded 90% of live births and 7.6% of Intra Uterine Fetal Demise or neonatal death. Perinatal outcomes were impacted by the dose of transfusion: logistic regression, correcting for age and assisted conception, showed that women transfused with 3 or more RBC units have about 3-fold higher risk of perinatal death (OR: 2.9, 95% CI: 1.0-8.4).

Discussion: In this series, several known risk factors were associated with adverse feto-neonatal outcome. In addition, the number of RBC units transfused was significantly and independently associated with the perinatal outcome. Present data can be helpful to design prospective studies taking into account timing and dose of transfusion during pregnancy with the objective to improve feto-maternal outcome.