A Comparison of Automated Red Blood Cell Depletion/Exchange to Automated Red Cell Blood Exchange in Sickle Cell Patients.

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 2281-2281 ◽  
Author(s):  
Kevin H.M. Kuo ◽  
David Barth
Keyword(s):  
Clinical Outcome ◽  
Blood Cell ◽  
Sickle Cell ◽  
Red Blood Cell ◽  
Conflicts Of Interest ◽  
P Value ◽  
Entire Study ◽  
Blood Exchange ◽  
Significant Difference ◽  
The Mean

Abstract Abstract 2281 Introduction: Chronic red blood cell (RBC) exchange transfusion (RBCX) is employed in the prevention and treatment of complications from sickle cell disease (SCD). Although regular automated RBCX by an apheresis device can consistently maintain a low sickle hemoglobin (HbS) percentage at a relatively constant hematocrit level (Hct) with no iron loading, it exposes the patient to significantly more donor erythrocyte units than simple (top-up) transfusion. Since October 2010 the University Health Network, a sickle cell comprehensive care centre in Canada, has started performing automated depletion RBCX with the Caridian Optia Apheresis System. In depletion/exchange, a portion of the patient's RBC is first cytapheresed by the apheresis device prior to the exchange phase of the procedure, with albumin as colloid replacement to maintain intravascular volume and pressure. The clinical effectiveness of depletion/exchange has not been demonstrated in a systematic manner. A retrospective observational cohort study was conducted to investigate the hypothesis that depletion/exchange RBCX, when compared to traditional automated RBCX, will reduce a patient's donor RBC exposure while providing similar hematological and clinical benefit. The laboratory and clinical outcome 1 year before (October 1, 2009) and 1 year after (October 30, 2011) the introduction of depletion/exchange RBCX were compared on a patient-by-patient, rather than on an aggregate, basis. Results: Seven patients, 2 females, 5 males, median age 29 years (range 26 – 38 years), totaling 135 RBCX sessions were examined. Five patients were homozygous for the sickle mutation and 2 were SC compound heterozygotes (HbSC). Stroke was the most prevalent indication (n = 3). Median interval between exchange sessions was 5 weeks (range 4 – 8 weeks). The fraction cell remaining (FCR) was fixed at 20 and did not change when patients were transitioned from non-depleted to depleted exchange. The minimum Hct was reduced to 0.24 in all patients. The inlet speed of the apheresis device and anticoagulant ratio employed were similar across all patients. There was no significant difference in pre-RBCX HbS (or HbS+C in HbSC patients) in 6 patients (P value ranged from 0.0589 to 0.6870). The pre-RBCX HbS was higher with depletion/exchange in 1 patient (P = 0.0071). There was no significant difference in post-RBCX Hct in 5 patients (P value ranged from 0.1056 to 0.8995), and in 2 patients, the mean post-RBCX Hct was lower with depletion/exchange (P = 0.0004 and 0.0148). The mean RBC volume used was reduced by 25 mL/kg/year with depletion/exchange. The mean volume of albumin used was 6.0 ± 2.5 mL/kg per session. Ferritin remained stable throughout the study period (P = 0.2289). None of the patients were on iron chelators. There was no significant difference in mean duration of RBCX session between depletion/exchange and non-depletion exchange in all patients except one. The median duration of one session was 148 ± 51 min. and 147 ± 43 min. in depletion/exchange and non-depletion exchange respectively. A total of 11 adverse events occurred in 135 sessions, with citrate reaction being the commonest (n = 4). There was no significant difference in the rate of adverse event between depletion and non-depletion RBCX (8/74 and 4/61 respectively, P = 0.3874). There was also no incidence of treatment failure, defined as the occurrence of an SCD-related complication in which the RBCX was intended to prevent, in any of the patients during the entire study period, regardless of RBCX method. Conclusion: In this first clinical study of depletion/exchange, this strategy significantly reduced RBC usage in majority of the patients without any negative impact on laboratory and clinical outcome. The use of depletion/exchange reduced RBC usage by 25 mL/kg/year, equivalent to 5 units of packed RBC in a 60 kg person. Further optimization of the technique by modification of the FCR and minimum Hct may yield higher reduction in RBC usage, thereby reducing the risk of exposure to blood products. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Frequency of red blood cell alloimmunization in sickle cell patients and healthy donors: the influence of racial and antigenic pattern differences

2017 ◽  
Vol 4 (7) ◽  
pp. 2226
Author(s):  
Majid Vafaei ◽  
Bijan Keikhaei-dehdazi
Keyword(s):  
Blood Cell ◽  
Sickle Cell ◽  
Red Blood Cell ◽  
Blood Donors ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Healthy Donors ◽  
Significant Difference ◽  
The Common ◽  
The Mean

Background: Red blood cell (RBC) transfusions are frequently used in patients with sickle cell disease (SCD) to treat and prevent of their disease complications. However repeated blood transfusions are often complicated by RBC alloimmunization. Race and antigenic pattern differences are the common risk factor to develop alloimmunization. This study was performed to determine the frequency of RBC alloimmunzation in sickle cell patients and healthy blood donors.Methods: This is a cross sectional study that has been done on 140 patients with SCD and 140 healthy blood donors from April 2015 to April 2016. The RBC phenotype of all patients and donors investigated by Tub method and all panel test phases were done at immunohematology laboratory of Iranian Blood Transfusion Organization of Ahwaz.Results: Of all SCD patients 61 (43.6%) were male and 79 (56.4%) were female. 68 (48.5%) were HbSS and 72 (51.4%) were S/B thalassemia. The mean age of patients was 19.69 (range: 2-60) years. Of all patients, 114 (81.25%) had received transfusion. The RBC alloimmunization rate among SCD patients was 7.1% and 50% of the RBC alloimmunization had anti-Kell and 30% had anti-Rh. The comparison of the RBC phenotypes between the group of patients with SCD and the group of blood donors (non-Arab) revealed a statistically significant difference in the frequency of S (54% vs. 67%, p=0.024), M (82.7% vs. 90.7%, p=0.049), and FYb (73.4% vs. 55.7%, p=0.002).Conclusions: Althoguh alloimmunization rate in SCD patients in this study was lower than reported by other studies but cross matchining at least for the Rh and Kell systems from the time of initial transfusion may decrease the incidence of alloimmunization. 

Hodgkin Lymphoma Outcomes: Can We Expect Ethnic Parity in a Hispanic Prevalent Population?

Blood ◽  
2019 ◽  
Vol 134 (Supplement_1) ◽  
pp. 4056-4056
Author(s):  
Michelle Janania Martinez ◽  
Prathibha Surapaneni ◽  
Juan F Garza ◽  
Tyler W Snedden ◽  
Snegha Ananth ◽  
...  
Keyword(s):  
Hodgkin Lymphoma ◽  
Conflicts Of Interest ◽  
Relative Survival ◽  
Complete Response ◽  
Statistical Testing ◽  
P Value ◽  
Hispanic Population ◽  
Significant Difference ◽  
The Mean

BACKGROUND It is estimated that 8110 persons will be diagnosed with Hodgkin Lymphoma (HL) in the US during 2019, but the advent of new treatment options has increased the cure rate to at least 80%. It has been reported that the rates of HL are lower in the adolescent and young adult (AYA) Hispanic population but significantly higher in the Hispanic population older than 65. The relative survival estimates are stated to be similar between AYA Hispanics (HI) and non-Hispanics (NH) but for ages 65-84, HI have a significantly higher mortality rate. Pediatric studies have suggested that ethnicity plays a role in outcomes in patients with HL but there is limited data in the adult population. There is an unmet need in the field, where dossiers on underrepresented ethnic minorities need to be carefully considered and compared to existing data. Therefore, our study aims to compare survival outcomes in Hispanics vs Non-Hispanics with HL, who were treated at the only NCI designated cancer center of South Texas. To our knowledge this is the largest cohort of HL patients from a single academic institution that serves primarily Hispanics. METHODS We located and retrospectively analyzed a total of 616 patients with diagnosis of Lymphoma (HL and NHL) by International Classification of Diseases (ICD) codes and identified 116 cases of HL; all the patients received care at UT Health San Antonio, between 2008-2018. Key variables for each patient included age, gender, race/ethnicity, comorbidities, insurance status, stage, BM and extranodal involvement, treatment received, outcome at 3 and 5 years and vitality status in 2018. Continuously distributed outcomes were summarized with the mean and standard deviation and categorical outcomes were summarized with frequencies and percentages. The significance of variation in the mean with disease category was assessed with one way ANOVA and the significance of associations between categorical outcomes was assessed with Pearson's Chi Square or Fisher's Exact test as appropriate. Multivariate logistic regression was used to model binary outcomes in terms of covariates and indicators of disease. All statistical testing was two-sided with a significance level of 5%. R1 was used throughout. The study was approved by the local Institutional Review Board. The findings will be available to patients, funders and medical community through traditional publishing and social media. RESULTS We identified 116 patients with HL, of which 73 were HI (63%), 43 NH (36%) and 1 not specified (1%). In regard to race, 92% identified as Caucasian, 4% as African American, 3% other and 1% Asian. The median age at diagnosis was 37.4, (SD 15.13). There were 49 females (42%) and 67 males (58%). The most common funding source was commercial insurance N=54 (47%), followed by a hospital payment plan N=30 (26%), Medicare N=16 (14%), unfunded N=13 (11%) and Medicaid N=3 (2%). Most prevalent co-morbidities were HTN N=28 (24%) and diabetes mellitus N= 23(20%); 50% of patients had no co-morbidities (N=63).At diagnosis ECOG of 0-1 was seen in 108 patients (93%); 8 were Stage I (7%), 39 stage II (33%), 32 stage III (28%), and 37 stage IV (32%). EBV was positive in 26 patients (22%). There were 15 patients that were HIV positive (13%), 54% with CD4 count <200, and 12 (75%) on antiretroviral therapy at diagnosis. Median PFS was 853.85 days (SD 912.92). We excluded patients who were lost to follow up or had not reached 3/5 years. At 3 year follow up there was: complete response in 37 HI (74%) vs 22 NH (92%); disease progression in 8 (16%) vs 0 (0%); death in 5 (10%) vs 2 (8%), respectively (p-value= 0.094). At 5 year follow up there was: complete response in 30 HI (77%) vs 17 NH (90%); progressive disease in 2 (5%) vs 0 (0); death 7 (18%) vs 2 (11%), respectively (p-value = 0.619). At the end of 2018, 41 HI (84%) were alive compared to 22 NH (88%) [p-value 0.74]. CONCLUSION Within the limitations of sample size, our study demonstrates that in the prevalently Hispanic population of our institution, HI patients with HL have no statistically significant difference in outcome when compared to NH patients. Disclosures No relevant conflicts of interest to declare.

Clinical Complications in Adult Patients with Sickle Cell Anemia and β-Thalassemia-Sickle Cell Disease

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 4767-4767
Author(s):  
Giovanna Graziadei ◽  
Alessia Marcon ◽  
Martina Soldarini ◽  
Ilaria Gandolfi ◽  
Luisa Ronzoni ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Acute Chest Syndrome ◽  
P Value ◽  
Cell Disease ◽  
Transfusion Therapy ◽  
Clinical Complications ◽  
Significant Difference ◽  
The Mean

Abstract Abstract 4767 Background. Sickle-Cell Disease (SCD) is one of the most common severe monogenic inherited disorders worldwide, due to hemoglobin S (HbS), with reduced affinity for the oxygen. HbS polymerization, leading to erythrocyte rigidity, vaso-occlusion and hemolytic anemia, is central in the pathophysiology and crucial for the clinical outcome. The term SCD refers to Sickle Cell Anemia (SCA) due to homozygosis for βS allele, HbS/β-thalassemia (T-SCD) due to compound of β-thal and βS allele, and HbSC disease, owing to the coinheritance of βS and βcalleles. SCD is a multiorgan disease characterized by recurrent acute events and progressive organ damage, worsening during the life. Aims. This is a retrospective monocentric study aimed to assess and compare the clinical complications among 59 adult SCD patients, followed at the Hereditary Anemia Centre of the Foundation IRCCS “Ca Granda” Ospedale Maggiore Policlinico, in Milan, Italy. Methods. Mutation analysis of the b globin gene was established by direct DNA sequencing on the ABI Prism 310 genetic analyzer. Clinical and hematological features were evaluated by routine tests and physical examination, with special attention to the erythropoiesis stress parameters as LDH values and extramedullary erythropoietic (EE) masses. Results. Fifty-nine adult SCD patients, 16 SCA and 43 T-SCD, were evaluated. In T-SCD patients detected b-mutations were severe (b°) in 69.8%, and moderate or mild (b+-b++) in 30.2%. The mean age of SCA patients was 36±9 and 41±11 years for T-SCD patients. For both groups the mean follow-up was 20±6 years, while the mean age at the presentation in our Centre was 32±8 years in SCA patients and 31±10 years in T-SCD ones. Five out of 16 (31.2%) SCA patients and 16/43 (37.2%) T-SCD patients were male. HbF mean levels were 6.9±5.1% and 10.1±7.2%, respectively in SCA and T-SCD group; surprisingly Hb mean levels were lower in SCA (9.3±1.3 g/dl) than in T-SCD (9.9±1.4 g/dl) patients. Comparing SCA and T-SCD, there was statistically significant difference in splenic features: splenectomy was performed in 2/16 (12.5%) SCA patients vs 21/43 (48.8%) T-SCD patients (p-value < 0.01). Splenomegaly was absent in SCA, while was detected in 11/22 (50%) T-SCD (p-value < 0.0001); all SCA patients had functional asplenia, not observed in T-SCD patients; splenic infarctions were absent in SCA patients and were detected in 7/22 (31.8%) T-SCD patients, of whom 5 had splenomegaly and 2 had normal spleen size (pvalue <0.001). On the other side, there was not statistically significant difference in the prevalence of stroke, acute chest syndrome (ACS), bone pain crisis, sepsis, leg ulcers and priapism. However, we observed some clinical differences, even if not statistically significant. Cholecistectomy was performed in 4/16 (25%) SCA patients vs 17/43 (39.5%) T-SCD patients, and gallstones were detected respectively in 5/12 (41.7%) and in 14/26 (53.8%) of SCA and T-SCD patients. Thrombotic events were absent in SCA patients, compared to 4/43 (9.3%) T-SCD patients. Furthermore, we detected EE in 3/16 (18.6%) SCA and in 3/43 (7%) T-SCD, all carrying b° thal mutations. We underlie that Hb levels and LDH values were higher in SCA than in T-SCD patients (823±295 vs 689±209 U/L). About the treatment, 14/16 (87.5%) SCA and 31/43 (72%) T-SCD underwent to top-up transfusion; 5/43 (11.6%) T-SCD were regularly transfused. Seven out of 16 (43.8%) SCA and 18/43 (41.8%) T-SCD patients were treated with Hydroxycarbamide (HU). Criteria for transfusion therapy were: painful crisis not responsive to HU, major clinical complications, such as stroke or ACS, extramedullary erythropoietic masses associated with high LDH levels and low Hb values. Conclusions. These data suggest that SCA and T-SCD patients have similar clinical course. Splenomegaly is present only in T-SCD patients, probably due to the increased amount of extravascular hemolysis. Surprisingly, SCA patients showed EE and lower Hb levels with higher LDH values compared to T-SCD ones. This could be related to the prevalence of intravascular hemolysis, that can lead to erythropoietic stress in SCA, even if tissues are better oxygenated in these patients because of biochemical characteristic of HbS in terms of decreased oxygen affinity. These observations could be important to evaluate transfusion and HU treatment. Disclosures: Cappellini: Novartis: Research Funding.

scholarly journals Prevalence of sickle cell trait and its association to renal dysfunction among blood donors at university of medical sciences teaching hospital, Ondo, Nigeria

2021 ◽  
Vol 21 (3) ◽  
pp. 1237-1242
Author(s):  
Akinwumi Ayodeji Akinbodewa ◽  
Adeyemi Ogunleye ◽  
Oluseyi Ademola Adejumo
Keyword(s):  
Renal Function ◽  
Sickle Cell ◽  
Blood Donors ◽  
Sickle Cell Trait ◽  
P Value ◽  
Healthy Donors ◽  
Significant Difference ◽  
High Prevalence ◽  
The Mean ◽  
Estimated Glomerular Filtration Rates

Introduction: Prospective blood donors are routinely screened for blood borne infections but medical illnesses and haemo- globin genotype are overlooked despite a high prevalence of haemoglobin AS among Nigerian donors. Objective: To determine the prevalence of haemoglobin AS and its association to renal function, if any. Method: Apparently healthy donors were studied between February and December 2018. Their haemoglobin genotype and, estimated glomerular filtration rates were determined. Results: There were 96 males (94.1%) and 6 (5.9%) females with mean age of 26.7±4.5 years (range 19-44 years) and mean eGFR of 103.97±19.00ml/min/1.73m2. Eighty one (79.4%) and 21 (20.6%) subjects had haemoglobin AA and AS geno- types respectively. The mean eGFR for subjects with haemoglobin AA and AS were 105.2±18.6ml/min/1.73m2 and 99.9 ± 21.2ml/min/1.73m2 respectively (p value = 0.270). Eighty one (79.4%), 20 (19.6%) and 1 (1.0%) subjects had renal function at >90ml/min/1.73m2, 60-89ml/min/1.73m2 and 30-59ml/min/m2 respectively. There was no significant difference in the mean eGFR between subjects with haemoglobin AA and AS (mean difference 5.3, p = 0.265, 95%CI = -4.07 to 14.60). Conclusion: The prevalence of sickle cell trait among Nigerian blood donors is high. There is no significant difference in the renal function status of blood donors with SCT and normal haemoglobin genotype. Keywords: Haemoglobin genotype; sickle cell trait; renal function; blood donor; Nigeria.

Red Blood Cell Alloimmunization and Hemolytic Disease of the Fetus and Newborn: New Approaches Using Animal Models

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. SCI-49-SCI-49
Author(s):  
Jeanne E. Hendrickson
Keyword(s):  
Bone Marrow ◽  
Blood Cell ◽  
Immune Globulin ◽  
Red Blood Cell ◽  
Placental Transfer ◽  
Conflicts Of Interest ◽  
Fetal Liver ◽  
Igg Subclasses ◽  
Hemolytic Disease ◽  
Blood Exchange

Abstract Women may become alloimmunized to foreign red blood cell (RBC) antigens after exposure during transfusion or pregnancy/delivery. These alloantibodies can be detrimental to developing fetuses/neonates, with six in every 1000 pregnancies being affected by maternal alloantibodies. Despite being described more than 80 years ago, hemolytic disease of the fetus and newborn (HDFN) has few preventive or therapeutic options. Outside of antigen avoidance, the most effective maternal preventive therapy to date is Rh immune globulin. However, it targets just one of the more than 50 antigens implicated in HDFN, and its mechanism of action remains unknown. Furthermore, treatment options for affected fetuses are limited largely to intrauterine transfusions of antigen negative RBCs. With a decrease in HDFN cases due to Rh(D), KEL has emerged as one of the most widely implicated antigens. We now describe a transgenic murine model in which the human KEL antigen is expressed on murine RBCs, with clinical significance in both pregnancy and transfusion settings. Transgenic animals were generated with expression of the human KEL2 antigen (referred to herein as KEL) on their RBCs using a β-globin promoter. KEL expression was evaluated on fetal liver and bone marrow erythroid precursors, mature RBCs, and organs. C57BL/6 or MuMT females were bred with transgenic heterozygous KEL males. Maternal serum was collected during pregnancy and after delivery, with anti-KEL glycoprotein responses measured by flow cytometric crossmatch. Newborn pups were evaluated for KEL positivity, degree of anemia, and presence of maternal anti-KEL. Additionally, the effect of anti-KEL alloantibodies on fetal RBC precursors was evaluated at multiple stages of gestation. Lastly, females alloimmunized through pregnancy were transfused with incompatible KEL RBCs labeled with a lipophilic dye, and females alloimmunized through transfusion were bred with KEL males. Transgenic mice have RBC specific expression of the KEL glycoprotein, with antigen detected on early and late RBC precursors in the fetal liver and bone marrow but not on any tested organ. Fetal/maternal blood exchange was maximally detected after delivery, with the majority of mothers developing anti-KEL glycoprotein antibodies (IgM and all IgG subclasses) within weeks of delivery. All IgG subclasses of anti-KEL crossed the placenta and bound to RBC precursors and mature RBCs in developing KEL positive pups; KEL negative pups had positive indirect antiglobulin tests. Maternal anti-KEL glycoprotein titers increased with antigen exposure, with fewer KEL positive pups born during successive pregnancies to alloimmunized C57BL/6 but not MuMT females. Affected KEL positive pups were anemic, and some were stillborn and hydropic-appearing. As has been described in humans, maternal anti-KEL alloantibodies suppressed the development of fetal KEL RBC precursors at all levels of maturation. Additionally, newborn pups had a relative reticulocytopenia, with reticulocyte recovery within a week after birth. Multiparous alloimmunized females exhibited rapid clearance of transfused incompatible KEL RBCs, and females alloimmunized through KEL RBC transfusion also had pups affected by HDFN. To the best of our knowledge, this is the first animal model of HDFN in which pregnancy stimulates alloantibodies to a paternally derived RBC antigen, with these alloantibodies being clinically significant in both pregnancy and transfusion settings. The anti-KEL glycoprotein alloantibodies generated in this model have similar effects on murine RBCs as anti-KEL1 alloantibodies have on human RBCs. Such effects include suppression of erythropoiesis, fetal anemia, and even hydrops fetalis. This model thus provides a platform to study not only the induction, placental transfer, and consequences of maternal RBC alloantibodies, but also to investigate potential preventive therapies (including “KEL” immune globulin). Long-term translational goals of this work include minimizing the dangers of RBC alloantibodies to developing fetuses and neonates, through the development of targeted maternal immunomodulatory therapies. Disclosures: No relevant conflicts of interest to declare.

Effect of the Erythrocyte Apheresis On Immunological Parameters in Sickle Cell Anemia Patients in Crisis Period.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 4191-4191
Author(s):  
Yurdanur Kilinc ◽  
Ferda Tekinturhan ◽  
Birol Guvenc ◽  
Refik Burgut ◽  
Ilgen Sasmaz ◽  
...  
Keyword(s):  
Blood Cell ◽  
Nk Cells ◽  
Sickle Cell ◽  
Sickle Cell Anemia ◽  
Conflicts Of Interest ◽  
Blood Perfusion ◽  
Body Volume ◽  
Surface Markers ◽  
Immunological Parameters ◽  
The Mean

Abstract Abstract 4191 PURPOSE: Erythrocyte apheresis is an effective therapy in the acute and chronic treatment of sickle cell anemia (SCA). The main goal of erythrocyte apheresis is to improve blood perfusion through reducing Hemoglobin S (HbS) to < %30 and keeping hemoglobin (Hb) at desired level. The aim of this study was to evaluate the effect of the erythrocyte apheresis on immunological parameters in SCA patients with crisis. METHODS Between February 2009 and June 2009, 37 patients (20 female / 17 male) received 44 apheresis treatments at Hemapheresis Unit of Cukurova University School of Medicine, Adana, Turkey. The median age was 22 (Range, 4-56) years and the mean body weight was 51.9±18.6 kilograms. The apheresis procedures were carried out using a Cobe Spectra Cell Separator. A mean of 1.77 body volume calculated red blood cell volumes were exchanged with a mean duration of 125.9±34.9 minutes (Table 1). Sickling negative and leukoreduced packed red cells were used for apheresis treatments. Hemoglobin electrophoreses, complete blood counts, immunoglobins, specific surface markers for T, B and natural killer (NK) cells were performed before and after each procedure. While three patients had a SCA-induced functional asplenia, none of the patients was HIV-seropositive. RESULTS The erythrocyte apheresis resulted in a decrease on white blood cell (WBC) counts as expected. Average pre and post apheresis WBC counts were 12883±5775/mm3 and 8506±3331/mm3 (p<0.001) respectively. Accordingly, a decrease in post procedure lymphocyte, monocyte and granulocyte counts was observed. Because small amounts of patient's plasma were removed with red blood cells during apheresis procedures, serum levels of immuglobulins were also decreased. CD3, CD4 and CD8 for T cells, CD11b for monocytes, CD20 for B cells, CD56 as a NK marker and CD45 for leukocytes were analyzed and all of surface markers showed an increase after erythrocyte apheresis. The average pre apheresis HbS level was 78.90±19.20%, whereas the mean post apheresis HbS level was found to be 23.85±13.27% (p<0.001) (Table 2). CONCLUSIONS The erythrocyte apheresis is an effective and rapid procedure to reduce HbS concentration without increasing blood viscosity. Apheresis treatments have also been found to be beneficial in decreasing the leukocyte counts and serum immunoglobulins levels in the blood. Flow cytometric analyses revealed that T, B and NK cells were increased after apheresis treatment. Interestingly, the change in CD4/CD8 ratio was not statistically significant (p>0.05). This shows that vascular wall integrity is maintained and apheresis can be safely performed in SCA patients. In our study, blood perfusion was restored and blood chemistry was improved to optimal levels after erythrocyte apheresis. As a result, crisis periods were shortened. Disclosures: No relevant conflicts of interest to declare.

scholarly journals Caring for Patients with Sickle Cell Disease during a Pandemic: Continuing to Provide Automated Red Blood Cell Exchange Transfusions in Difficult Times

Blood ◽  
2020 ◽  
Vol 136 (Supplement 1) ◽  
pp. 25-26
Author(s):  
Richard Curtis Godby ◽  
Ashton Kornbrust ◽  
Denis Noubouossie ◽  
Jose Lima ◽  
Marisa B. Marques ◽  
...  
Keyword(s):  
Sickle Cell Disease ◽  
Blood Cell ◽  
Sickle Cell ◽  
Red Blood Cell ◽  
Blood Product ◽  
T Test ◽  
World Health ◽  
Cell Disease ◽  
Global Pandemic ◽  
The Mean

Introduction: The World Health Organization declared COVID-19 a global pandemic on 03/11/20. Subsequent concerns around caring for patients with sickle cell disease who require automated red blood cell (RBC) exchange transfusions emerged, especially in the setting of physical distancing and national shortages in blood product supplies. In this vulnerable population at high risk of allo-immunization, ideal transfusion parameters (e.g., antigen optimization) will likely grow increasingly difficult to satisfy and require careful evaluation and strategic planning. Methods: Automated RBC exchange transfusions were performed at the University of Alabama at Birmingham (UAB) in patients with sickle cell disease for a variety of clinical indications with the primary objective of lowering the amount of Hemoglobin S (goal 15%) and replacing it with Hemoglobin A. We collected the number of weekly RBC exchange transfusions performed and then compared the frequencies between 01/05/20 and 03/14/20 (pre-pandemic) to those between 03/15/20 and 08/01/20 (intra-pandemic) using a one-tailed t-test. We also examined the number of RBC units ordered per week at UAB, in both the inpatient and outpatient settings, shortly before and after the declaration of a global pandemic using a one-tailed t-test. Results: The mean frequency of RBC exchange transfusions performed per week was 8.1 [standard deviation 2.3] pre-pandemic and 8.6 [2.3] intra-pandemic (Figure 1a). There was no statistically significant difference (p=0.27) in the frequency between these two periods. Shortly prior to the start of the pandemic (02/23/20-03/14/20), a mean of 77.3 [17.9] units/week were ordered for outpatient RBC exchange transfusions. Shortly after the start of the pandemic (03/15/20-04/26/20), a mean of 55.3 [22.8] units/week were ordered for outpatient RBC exchange transfusions, which was also not significantly different (p=0.09). During this time period, the mean number of RBC units per week ordered in the inpatient surgical setting significantly declined from 719.3 [43.1] to 390.0 [46.8] as elective procedures were delayed (p&lt;0.005) (Figure 1b). Conclusions/Future Directions: The frequency of automated RBC exchange transfusions performed at UAB did not decrease after the onset of the pandemic. UAB was able to continue caring for patients with sickle cell disease receiving RBC exchange transfusions as the pandemic emerged and national blood product supplies declined despite a similar overall demand. Interestingly, there was also a concomitant decrease in the demand for RBCs from inpatient surgical settings as elective procedures were delayed, possibly contributing to the blood bank's ability to maintain ideal transfusion parameters and perform antigen optimization of transfused RBCs. As the COVID-19 pandemic continues, the national shortage of blood product supplies will likely worsen and necessitate multidisciplinary efforts, including intra-institutional and inter-institutional collaborations, to continue caring for patients with sickle cell disease receiving RBC exchange transfusions. Furthermore, community education, safely structured blood drives, and other efforts to encourage donations are essential to maintain the national blood product supply. Disclosures No relevant conflicts of interest to declare.

scholarly journals Correlation between Red Blood Cell Distribution width, Neutrophil to Lymphocyte Ratio and Neutrophil to Platelet Ratio with 3-month Prognosis of Patients with Intracerebral Hemorrhage: A Retrospective Study

2022 ◽  
Author(s):  
Sheida Shaafi ◽  
Ehsan Bonakdari ◽  
Yalda Sadeghpour ◽  
Seyed Aria Nejadghaderi
Keyword(s):  
Prognostic Factor ◽  
Blood Cell ◽  
Intracerebral Hemorrhage ◽  
Red Blood Cell ◽  
Large Scale ◽  
Complete Blood Count ◽  
Cell Distribution ◽  
Distribution Width ◽  
Significant Difference ◽  
The Mean

Abstract Background: Red cell distribution width (RDW) is a parameter that indicates the heterogeneity of red blood cell size and could be as a prognostic factor in some diseases. Also, intracerebral hemorrhage (ICH) is considered a vascular event with a high mortality rate. Here, we aimed to examine the role of RDW, neutrophil to lymphocyte (NLR) and neutrophil to platelet ratios (NPR) in predicting the prognosis of patients with ICH.Methods: This is a retrospective cohort study which conducted on 140 patients with ICH admitted to the neurology ward and intensive care unit (ICU) in Imam Reza Hospital, Tabriz, Iran. Demographic data, National Institutes of Health Stroke Scale (NIHSS), and complete blood count (CBC) test parameters evaluated within 24 hours after hospitalization. These variables collected and re-evaluated three months later. Results: The mean age of the study population was 61.14 (±16) years and 51% were male. RDW had a significant positive correlation with hemoglobin concentration (r=0.3; p<0.001) and significant negative correlation with MCHC (r=-0.57; p<0.001) and neutrophil count (r=-0.235; p=0.006). Also, the mean NLR (p=0.05), neutrophil and platelet count (p=0.05), NIHSS (p=0.05), and RDW (p=0.01) had a significant difference between the deceased patients and those who partially recovered after 3 months. Moreover, the results of logistic regression showed variables including RDW (p=0.006) and NIHSS (p<0.001) levels were correlated significantly with mortality. Conclusion: RDW could be an appropriate prognostic factor and predictor in determining 3-months survival in ICH. Nevertheless, further large-scale prospective cohorts might be needed to evaluate the associations.

scholarly journals Effects of the walnut Plukenetia conophora shell in the diet on the growth performance and genotoxicity of the African catfish Clarias gariepinus

2019 ◽  
Vol 4 (2) ◽  
pp. 99-110
Author(s):  
Simeon O. Ayoola ◽  
Loveth N. Omoile
Keyword(s):  
Blood Cell ◽  
Growth Performance ◽  
White Blood Cell ◽  
Red Blood Cell ◽  
Clarias Gariepinus ◽  
Walnut Shell ◽  
African Catfish ◽  
Fish Feed ◽  
Significant Difference ◽  
The Mean

Aquaculture industry is facing challenges of the high cost of fish feed, and therefore it is very crucial to explore the alternative raw materials for feed formulation at the lowest cost. Therefore, the objective of the present study was to evaluate the effect of Plukenetia conophora shells on the growth, haematological and biochemical parameters, and its genotoxicity on African catfish Clarias gariepinus juveniles. Five experimental diets were formulated having three replicates at 0% (0WS), 25% (25WS), 50% (50WS), 75% (75WS) and 100% (100WS) inclusion of walnut shell respectively. The fishes were fed on experimental diet two time a day for 12 weeks. The results showed that the fish in tank 25WS had the best weight gain with the mean of 33.5±5.8 g and the least was recorded in tank 100WS. The specific growth rate was highest in-tank 75WS with the mean value of 0.46±0.05 g was recorded. The highest feed intake was found in fish fed with 25% inclusion of P. conophora.  The fish fed with P. conophorashowed increased values of haemoglobin, (12.05±1.63g/dL), Red blood cell, (2.785±0.28µL) and White blood cell, (11.25±4.59µL) compared with control diet values of fish fed of  Red blood cell, (1.81±1.54µL) and White blood cell, (5.15±6.57µL). There was a reduction in the haematological value of the fish fed with control feed having Haemoglobin, (10.75±8.13g/dL). The genotoxicity test that was carried out showed that the highest counts of micronucleus were in tank 75WS. The Duncan Multiple Range Test (DMRT) shows a significant difference (p0.05) in the growth performance of the fish. It is concluded that inclusion of 50% P. conophora shells in the feed of C. gariepinus gave no negative impact on the health status  and growth performance of the fish.  Keywords: Toxicity test, Growth indices, Plukenetia conophora, Clarias gariepinus  

A Comparison of Chronic Manual and Automated Red Blood Cell Exchange Transfusion in Sickle Cell Disease Patients From Two Comprehensive Care Centres in the United Kingdom

Blood ◽  
2012 ◽  
Vol 120 (21) ◽  
pp. 3430-3430 ◽  
Author(s):  
Kevin H.M. Kuo ◽  
Richard Ward ◽  
Jo Howard ◽  
Paul Telfer
Keyword(s):  
Sickle Cell Disease ◽  
Adverse Events ◽  
Blood Cell ◽  
Sickle Cell ◽  
Red Blood Cell ◽  
Antibody Formation ◽  
Individual Variability ◽  
Cell Disease ◽  
Significant Difference ◽  
Manual Group

Abstract Abstract 3430 Chronic transfusion is indicated in the treatment and prevention of sickle cell disease (SCD) related-complications. Red blood cell exchange (RBCX) is preferred over top-up transfusion as it enables iron balance and rapid reduction of sickle hemoglobin (HbS) without increasing blood viscosity. RBCX can be done manually by sequential phlebotomy and transfusion or by automated apheresis, but the two methods have not been formally compared. Bart's Health NHS Trust (BHT) performs manual RBCX and Guy's and St. Thomas NHS Trust (GSTT) automated RBCX. Manual RBCX consists of isovolumetric exchange 15 to 20 mL/kg of venesected blood for normal saline and packed RBC, generally at a 1:1 ratio. Automated RBCX utilizes the Spectra Optia Apheresis System with a fractional cell remaining between 24 and 44, end Hct within 0.02 of pre-RBCX Hct, and a fluid replacement balance of 100%. The indications for RBCX and pre-RBCX HbS or hemoglobin SC (HbSC) target (30% or 50%, depending on indication) are the same in both units. All packed RBC were leukodepleted, HbS negative, ≤ 7 days old, and phenotypically matched for C, D, E, and Kell. A retrospective observational cohort study as part of a quality assurance audit was conducted examining all SCD patients attending regular RBCX at BHT and GSTT between 1 May 2011 and 30 April 2012. Fifty-one patients (21 manual, 30 automated), totaling 401 RBCX sessions were included. Ten patients in the manual group and 7 patients in the automated group targeted an HbS of < 30%, while the rest were targeted to < 50%. There was no significant difference in baseline characteristics between the two groups. Peripheral vein was the most common method of cannulation in manual RBCX while temporary central venous catheterization was most common in automated RBCX (P < 0.0001). Time interval differed between manual and automated RBCX (median 4.4 vs. 7.1 weeks, P < 0.0001). Both groups consistently achieved a post-RBCX Hct < 0.350. More patients on automated RBCX were able to consistently achieve their prescribed HbS or HbSC target (defined as > 2/3 of RBCX sessions) than on manual RBCX (37% vs. 10%, unadjusted OR 5.5, 95% CI 1.07 – 28.22, P = 0.048). When adjusted for the prescribed pre-RBCX HbS or HbSC target, the Mantel-Haenszel OR estimate was 4.72 (95% CI 0.885 – 25.17). Older age was also associated with consistently achieving the prescribed HbS or HbSC target (P = 0.010 on multivariable logistric regression). Although the yearly volume of RBC and donor units used were significantly higher in the automated group (241.1 mL/kg/year and 55 units/year) compared to the manual group (127 mL/kg/year and 32 units/year), there was no difference in the rate of allo-antibody formation. There was no difference in the mean ferritin trend between manual and automated RBCX in non-chelated patients (−0.068 ± 1.439 vs. −0.297 ± 2.027 ug/L/day, P = 0.439). Automated RBCX was better at maintaining a near zero iron balance than manual RBCX due to considerable individual variability in the manual group (kurtosis statistic 13.221 ± 0.935 SE vs. 0.398 ± 1.121 SE). It took a significantly longer time to perform a manual RBCX session than an automated one (257 min. vs. 115 min.). There was no significant difference in the number of adverse events. The number of RBCX sessions that had to be converted to top-up transfusions in the manual group because of low pre-RBCX haematocrit far exceeded that of the automated group (11 vs. 0 sessions). None of the patients in either group had new or progressive neurological events. Manual RBCX, despite an optimized protocol and strict adherence to treatement, is inferior to automated RBCX in being able to consistently achieve the prescribed HbS target, although consistent adherence with automated RBCX can also be challenging. Automated RBCX requires less time to perform than manual RBCX, but involves higher RBC use and more donor exposure. Adverse events and antibody formation are the same for both methods. Automated RBCX can maintain a near zero iron balance in most patients without the use of iron chelation and with less individual variability than manual RBCX. The results suggest that automated RBCX is the preferred RBC exchange method in controlling HbS in SCD patients. Further longitudinal study is required to determine whether a better control of HbS translates into differences in patient-related outcomes. Disclosures: No relevant conflicts of interest to declare.

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