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Successful use of therapeutic plasma exchange for the management of acute lung transplant rejection secondary to immune checkpoint inhibitor therapy 成功使用治疗性血浆置换治疗继发于免疫检查点抑制剂疗法的急性肺移植排斥反应
IF 1.4 4区 医学 Q4 HEMATOLOGY Pub Date : 2024-10-23 DOI: 10.1016/j.transci.2024.104024
Junaid Ahmad Wali , Muharrem Yunce , Naureen Narula
The use of immune checkpoint inhibitors (ICIs) in individuals with a history of solid organ transplantation is fraught with the emergence of solid organ transplantation rejection (SOTR). The current recommendations for the management of SOTRs secondary to ICI include the use of high-dose steroids along with the escalation of immunosuppressive therapy. Therapeutic Plasma Exchange (TPE) has been described to be effective in managing various immune-related toxicities, however, the data for using TPE in the setting of acute SOTRs induced by ICIs are limited. Herein, we describe the successful use of TPE in a patient with a history of bilateral lung transplantation who developed an episode of mixed acute cellular and antibody-mediated lung transplant rejection after a single dose of PD-1 inhibitor Pembrolizumab for the treatment of underlying melanoma.
在有实体器官移植史的患者中使用免疫检查点抑制剂(ICIs)时,可能会出现实体器官移植排斥反应(SOTR)。目前针对 ICI 继发性 SOTR 的治疗建议包括使用大剂量类固醇和升级免疫抑制疗法。据描述,治疗性血浆置换(TPE)可有效控制各种免疫相关毒性反应,但在 ICI 诱导的急性 SOTR 中使用治疗性血浆置换的数据却很有限。在本文中,我们介绍了在一位有双侧肺移植史的患者身上成功使用 TPE 的情况。该患者在单剂量使用 PD-1 抑制剂 Pembrolizumab 治疗潜在的黑色素瘤后,出现了急性细胞和抗体介导的混合性肺移植排斥反应。
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引用次数: 0
International forum: WAA meets in Yogaykarta 国际论坛:世界气象组织在约盖卡尔塔举行会议
IF 1.4 4区 医学 Q4 HEMATOLOGY Pub Date : 2024-10-23 DOI: 10.1016/j.transci.2024.104021
Gail Rock
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引用次数: 0
Advancement of blood donor factors in RBC and blood component therapy using modern practices and methodologies: How to make multifactorial clinical decisions amid growing complexity 利用现代实践和方法推进红细胞和血液成分治疗中的献血因素:如何在日益复杂的情况下做出多因素临床决策。
IF 1.4 4区 医学 Q4 HEMATOLOGY Pub Date : 2024-10-22 DOI: 10.1016/j.transci.2024.104022
Nishaka William , Jason P. Acker , Jerard Seghatchian
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引用次数: 0
GRAIN Study - Granulocytes Against Infections - Use of granulocyte transfusion in haematopoietic stem cell transplant GRAIN 研究--粒细胞抗感染--造血干细胞移植中粒细胞输注的应用
IF 1.4 4区 医学 Q4 HEMATOLOGY Pub Date : 2024-10-19 DOI: 10.1016/j.transci.2024.104020
Karthik Rengaraj , Steven Lionel , Sushil Selvarajan , Uday Prakash Kulkarni , N.A. Fouzia , Anu Korula , Aby Abraham , Kavitha Lakshmi , Alok Srivastava , Vikram Mathews , Biju George , Dolly Daniel , Mahasampath Gowri , Sharon Anbumalar Lionel
Granulocyte transfusions (GTx) combat infections in neutropenic patients. However, immune-mediated off-target effects in transplant settings are unknown. Between January 2020 and December 2021, all transplants that used GTx during the peri-transplant period were analysed. Engraftment, infections, and days to clearance were retrieved from clinical records. Overall survival is compared with the mean total PMN count and the different products. Pooled buffy coat was used in 110 patients (98 %), of which 38 (34 %) additionally received an apheresed product. The median days of GTx was 4. The median bags pooled to prepare a single buffy coat product was 4. The mean total PMN count was 0.98 × 1010/ L granulocytes per pooled buffy coat and 1.93 × 1010/L granulocytes per apheresis product. A higher PMN count (>1 × 1010/L) was achieved in 48 % with pooled buffy coat versus 85 % with apheresis. Respiratory worsening occurred in 39 % receiving GTx. All patients who received granulocytes had engrafted with a median time of 14 days for neutrophil and 20 days for platelet engraftment. Blood cultures cleared in 81 %, whereas only 28 % cleared other cultures. Fungal pneumonia cleared in 25 %, and invasive fungal sinusitis or otitis cleared in 50 %. Overall survival was 47 %, non-significantly higher (57 % vs 39 %, P = 0.1) with a higher PMN dose. The pooled buffy coat is an affordable alternative to apheresis for an effective PMN dose. Ease of availability and low cost of pooled buffy coat, with comparable overall survival points toward a safe and efficacious product, in the peri-transplant period.
粒细胞输注(GTx)可防治中性粒细胞减少患者的感染。然而,移植环境中免疫介导的脱靶效应尚不清楚。在 2020 年 1 月至 2021 年 12 月期间,对所有在移植围手术期使用过 GTx 的移植手术进行了分析。从临床记录中检索了移植、感染和清除天数。将总存活率与平均 PMN 总计数和不同产品进行比较。110名患者(98%)使用了集合水包衣,其中38名患者(34%)还使用了无细胞产品。GTx天数的中位数为4天,用于制备单个水包衣产品的集合袋数的中位数为4袋。每个集合水包衣的平均PMN总数为0.98×1010/L粒细胞,每个无细胞产品的平均PMN总数为1.93×1010/L粒细胞。48%的人使用集合水包衣获得了较高的 PMN 数量(1 × 1010/L),而 85% 的人使用无细胞血浆获得了较高的 PMN 数量。接受 GTx 治疗的患者中有 39% 出现呼吸恶化。所有接受粒细胞移植的患者中,中性粒细胞移植的中位时间为 14 天,血小板移植的中位时间为 20 天。81%的患者血液培养物清除,而只有 28%的患者其他培养物清除。真菌性肺炎治愈率为 25%,侵袭性真菌性鼻窦炎或中耳炎治愈率为 50%。总体存活率为 47%,PMN 剂量越高,存活率越高(57% 对 39%,P = 0.1),但无显著性差异。就有效的 PMN 剂量而言,汇集缓冲衣是一种经济实惠的无细胞疗法替代方法。在围移植期,集合水包衣易于获得且成本低廉,总体存活率相当,这表明它是一种安全有效的产品。
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引用次数: 0
Red blood cell alloimmunization in transfused patients with hereditary hemorrhagic telangiectasia: A single centre retrospective study 遗传性出血性毛细血管扩张症输血患者的红细胞同种免疫:一项单中心回顾性研究。
IF 1.4 4区 医学 Q4 HEMATOLOGY Pub Date : 2024-10-18 DOI: 10.1016/j.transci.2024.104019
Alexandra Grudzinski , Brandon Tse , Russel Ombao , Marie E. Faughnan , Katerina Pavenski

Background

Hereditary hemorrhagic telangiectasia (HHT) is a genetic blood vessel disorder which may lead to chronic bleeding and red blood cell (RBC) transfusions. Data on transfusion requirements and complications in HHT patients are sparse.

Study Design and Methods

Retrospective chart review was conducted at St. Michael’s Hospital (SMH) in Toronto, Canada. All adults with a definite clinical diagnosis of HHT AND inpatient hospital visits between January 1, 2011 and December 31, 2020 AND had undergone transfusion compatibility testing at SMH, were identified. Data were abstracted from electronic medical records. Simple descriptive statistics were used to analyze data. Institutional Research Ethics Board approval was obtained.

Results

63 HHT patients underwent compatibility testing and were subsequently transfused at SMH. Median patient age at data abstraction was 70 years (Interquartile Range [IQR]: 18) and 35 (56 %) were female. RBC alloantibodies were found in 23 transfused patients (36.5 %) and were predominantly directed against Rh and Kell antigens: Anti-E (65 %), Anti-K (39 %) and Anti-c (22 %) were most common. Excluding an outlier who received 611 RBC units during the study period, the mean number of RBC units transfused per HHT patient at SMH was 22.1 units (Standard Deviation: 40.9, IQR: 17). Six (9.5 %) transfused patients experienced at least one transfusion reaction.

Conclusion

RBC alloimmunization rate was 36.5 % in our cohort of transfused HHT patients; this is much higher than described in the general population and another transfused HHT cohort. The most commonly observed alloantibodies were Rh and Kell, supporting our policy of prophylactic phenotypic matching for these antigens for all transfused patients with HHT.
背景:遗传性出血性毛细血管扩张症(HHT遗传性出血性毛细血管扩张症(HHT)是一种遗传性血管疾病,可导致慢性出血和红细胞(RBC)输血。有关 HHT 患者输血需求和并发症的数据很少:加拿大多伦多圣迈克尔医院(SMH)进行了回顾性病历审查。2011年1月1日至2020年12月31日期间,所有临床诊断明确为HHT的成人住院患者均在SMH接受了输血相容性测试。数据摘录自电子病历。数据分析采用简单的描述性统计方法。结果:63名HHT患者接受了相容性测试:63名HHT患者接受了相容性测试,随后在SMH接受了输血。抽取数据时患者的中位年龄为70岁(四分位距[IQR]:18),35人(56%)为女性。在 23 名输血患者(36.5%)中发现了红细胞异体抗体,主要针对 Rh 抗原和 Kell 抗原:最常见的是抗-E(65%)、抗-K(39%)和抗-c(22%)。除去一名在研究期间接受了 611 个红细胞单位的异常值患者,SMH 为每名 HHT 患者平均输注了 22.1 个红细胞单位(标准偏差:40.9,IQR:17)。6名(9.5%)输血患者至少出现过一次输血反应:结论:在我们的输血型 HHT 患者队列中,红细胞异体免疫率为 36.5%,远高于普通人群和其他输血型 HHT 患者队列中的数据。最常见的异体抗体是 Rh 和 Kell,这支持了我们对所有输血的 HHT 患者进行这些抗原的预防性表型匹配的政策。
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引用次数: 0
Bacterial contamination of platelets concentrates in a lower middle-income country: Data from a single tertiary care hospital 中低收入国家浓缩血小板的细菌污染:来自一家三级医院的数据
IF 1.4 4区 医学 Q4 HEMATOLOGY Pub Date : 2024-10-17 DOI: 10.1016/j.transci.2024.104018
Bhawna Kumari , Muhammad Hasan , Seema Irfan , Abdullah Khalid , Bushra Moiz

Background

Transfusion of bacterially contaminated platelets may cause life threatening sepsis in the recipients. Cost of platelet screening is a major challenge for low middle income countries (LMICs). In this study, we evaluated the frequency of bacterial contamination in the platelet units (PUs) and the outcome of transfusing such platelets to the patients in a single institute at Pakistan.

Material and methods

During 2018–2022, whole blood-derived (WB-PU) and apheresis platelets (AP) were screened by BacT-ALERT® automated system. Single sample from each AP and samples from ≤ 5 WB-PUs were pooled and cultured within 24 h-post collection. An initial positive signal was followed by re-culture, Gram’s staining, pool resolution and bacterial identification. Results were interpreted as ‘confirmed positive’ or ‘indeterminate’ and ‘confirmed negative’ based on differences in initial-reactive and final results.

Results

A total of 84246 PUs (476 AP and 83770 WB-PU) was screened, and 239 (0.28 %) culture bottles were positive on day one. Individual cultures were performed on 1378 PUs (239 bottles) for pool resolution. Seven of 1378 (0.5 %) PUs were ‘confirmed positive’ while 1371 (99.4 %) were ‘indeterminate’. No bacterial growth was observed in 82868 (82392 WB-PU and 476 AP) of 84246 (98.3 %). Overall bacterial contamination rate was low at 1 in 12000 PUs approximately. Seven patients were transfused with contaminated PUs but no transfusion reaction was observed.

Conclusion

An insignificant risk of bacterial contamination was observed in this study but remains a concern for patient safety. LMICs need cost effective but efficient techniques to screen platelets for the presence of bacteria.
背景输注受细菌污染的血小板可能会导致受血者发生危及生命的败血症。血小板筛查的成本是中低收入国家(LMICs)面临的一大挑战。在这项研究中,我们评估了巴基斯坦一家研究所的血小板单位(PU)中细菌污染的频率以及向患者输注此类血小板的结果。材料和方法在 2018-2022 年期间,使用 BacT-ALERT® 自动系统筛查了全血血小板(WB-PU)和分离血小板(AP)。在采集后 24 小时内,将每个 AP 的单个样本和≤5 个 WB-PU 的样本集中起来并进行培养。出现初始阳性信号后,进行再次培养、革兰氏染色、池解析和细菌鉴定。结果共筛查出 84246 个 PU(476 个 AP 和 83770 个 WB-PU),第一天有 239 个(0.28%)培养瓶呈阳性。对 1378 个 PU(239 个培养瓶)进行了单个培养,以解决集合问题。1378 个 PU 中有 7 个(0.5%)"确认阳性",1371 个(99.4%)"不确定"。在 84246 瓶(98.3%)中,有 82868 瓶(82392 瓶 WB-PU 和 476 瓶 AP)未观察到细菌生长。总体细菌污染率较低,约为 12000 个 PU 中有 1 个受到污染。七名患者输注了受污染的 PU,但未观察到输血反应。低收入国家需要成本低、效率高的技术来筛查血小板中是否存在细菌。
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引用次数: 0
Biographies of the TAS Senior and his Guest Editor for the Theme papers on donors factors TAS Senior 及其捐助方因素主题文件特邀编辑的简历。
IF 1.4 4区 医学 Q4 HEMATOLOGY Pub Date : 2024-10-17 DOI: 10.1016/j.transci.2024.104015
Jerard Seghatchian, Jason Acker
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引用次数: 0
Guest Editorial: Advancements in blood donor factors: Understanding their variability and implications on the clinical outcomes of recipients. Where are we now! 特邀社论:献血因子的进展:了解其变异性及其对受血者临床结果的影响。我们现在在哪里?
IF 1.4 4区 医学 Q4 HEMATOLOGY Pub Date : 2024-10-16 DOI: 10.1016/j.transci.2024.104014
Jerard Seghatchian, Jason Acker
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引用次数: 0
It’s in your blood: The impact of age, sex, genetic factors and exposures on stored red blood cell metabolism 它就在你的血液里年龄、性别、遗传因素和暴露对储存的红细胞代谢的影响
IF 1.4 4区 医学 Q4 HEMATOLOGY Pub Date : 2024-10-15 DOI: 10.1016/j.transci.2024.104011
Angelo D’Alessandro
Transfusion of packed red blood cell (RBCs) saves millions of lives yearly worldwide, making packed RBCs the most commonly administered drug in hospitals after vaccines. However, not all blood units are created equal. By examining blood products as they age in blood banks, transfusion scientists are gaining insights into the intricacies of human chemical individuality as regulated by biological factors (such as sex, age, and body mass index), genetic and non-genetic factors like environmental, dietary, and other exposures. Here, we review recent literature on this topic, with an emphasis on studies linking genetic traits to the metabolic heterogeneity of blood products, the hemolytic propensity of stored RBCs, and transfusion outcomes in both healthy autologous and non-autologous patients requiring transfusion. Given the role of RBCs as a simplified model of eukaryotic cells, and RBC storage as a medically relevant application modeling erythrocyte responses to oxidant stress, these insights have the potential not only to guide the development of precision transfusion strategies, but also to identify novel mechanisms of RBC metabolic regulation relevant to responses to hypoxia and oxidant stress in human (patho)physiology.
全世界每年通过输注包装红细胞(RBC)挽救了数百万人的生命,使包装红细胞成为继疫苗之后医院最常用的药物。然而,并非所有血液单位都是一样的。通过研究血库中老化的血液制品,输血科学家们正在深入了解人类化学个体受生物因素(如性别、年龄和体重指数)、遗传和非遗传因素(如环境、饮食和其他暴露)调节的复杂性。在此,我们回顾了有关这一主题的最新文献,重点是将遗传特征与血液制品的代谢异质性、储存的红细胞的溶血倾向以及需要输血的健康自体和非自体患者的输血结果联系起来的研究。鉴于红细胞是真核细胞的简化模型,而红细胞贮存是红细胞对氧化应激反应建模的医学相关应用,这些见解不仅有可能指导精准输血策略的开发,还能发现与人类(病理)生理学中缺氧和氧化应激反应相关的红细胞代谢调节新机制。
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引用次数: 0
Haemolysis in red blood cell components is associated with donor ferritin and body mass index status, but not donation frequency 红细胞成分中的溶血与捐献者的铁蛋白和体重指数状况有关,但与捐献频率无关。
IF 1.4 4区 医学 Q4 HEMATOLOGY Pub Date : 2024-10-15 DOI: 10.1016/j.transci.2024.104009
Joanne C.G. Tan , Yeojoon Cha , Htet Htet Aung , Joanna Speedy , Denese C. Marks
Whole blood donors who donate more frequency are more likely to develop iron deficiency, which could potentially affect the quality of the red blood cell (RBC) components during storage. Additional donor factors such as sex, age at donation, donor body mass index (BMI), as well as the manufacturing method could also affect RBC component quality, particularly haemolysis. The aim of this study was to examine the relationship between donation frequency, donor ferritin levels and BMI status on an extensive set of RBC characteristics in vitro, during storage at 2–6 °C for 42 days. A whole blood donation was collected from 787 Australian blood donors, held overnight, before top-and-bottom separation to produce RBC components. RBC components were tested using a panel of in vitro assays. Serum ferritin was tested from a sample taken at the time of donation, and donor demographic data was collected. Haemolysis in RBC components was not found to be associated with donation frequency. Increased red cell haemolysis, lactate concentration, extracellular potassium and RBC-derived microparticle numbers were significantly associated with a high BMI in male donors. There was also a trend towards increased red cell haemolysis in donors with ferritin concentrations in the upper range. Our findings indicate that although older male donors with potentially higher BMI are able to donate whole blood quite frequently, the resultant RBC components may have poorer in vitro quality.
捐献次数越多的全血捐献者越容易缺铁,这可能会在储存过程中影响红细胞(RBC)成分的质量。其他捐献者因素,如性别、捐献年龄、捐献者体重指数(BMI)以及制造方法也会影响红细胞成分的质量,尤其是溶血。本研究的目的是检测在 2-6 °C 下储存 42 天期间,捐献频率、捐献者铁蛋白水平和 BMI 状态对一系列体外 RBC 特征之间的关系。从 787 名澳大利亚献血者中采集了全血,保存过夜后进行上下分离以产生红细胞成分。使用一系列体外检测方法对红细胞成分进行检测。从献血时采集的样本中检测血清铁蛋白,并收集献血者的人口统计学数据。结果发现,红细胞成分溶血与捐献频率无关。在男性捐献者中,红细胞溶血、乳酸浓度、细胞外钾和红细胞衍生微颗粒数量的增加与高体重指数显著相关。铁蛋白浓度处于上限范围的捐献者红细胞溶血也有增加的趋势。我们的研究结果表明,虽然体重指数可能较高的老年男性献血者能够经常捐献全血,但由此产生的红细胞成分的体外质量可能较差。
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引用次数: 0
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Transfusion and Apheresis Science
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