The Main Complications in Patients with Acute Leukemia during the Period of Myelotoxic Agranulocytosis

Annotation: Improvement of chemotherapeutic protocols and algorithms of accompanying treatment made it possible to increase the survival rate of patients with tumors of the blood system. Despite these advances, most of the cytostatic drugs currently widely used to treat patients with hemoblastosis, in addition to the antitumor effect, also cause myelosuppression and the development of granulocytopenia. Granulocytopenia is one of the main factors associated with infectious complications in patients with tumors of the blood system. The nature of infectious complications may differ depending on the duration of granulocytopenia. Keywords: agranulocytosis, immune agranulocytosis, myelotoxic agranulocytosis, acute lymphoblastic leukemias, level of persuasion of recommendations.

CHANGES IN HEMATOLOGICAL PARAMETERS IN HENS DURING SHORT-TERM INFLUENCE OF NEGATIVE ENVIRONMENTAL FACTORS

Comparative analysis of changes in hematological parameters of hens under short-term exposure to various negative environmental factors was performed. For this purpose in the conditions of a modern complex on production of food eggs 3 groups of hens were formed, each of which was kept in a separate cage-analogue on the area and the equipment. In particular, the hens of the 2nd group were deprived of fodder, the 3rd group – of light, and the 4th group – were kept with a significant overcrowding. Exposure to the factor in all groups was 24 hours, after which hematological parameters were determined. Differences in the response of the blood system of hens to short-term exposure to adverse environmental factors depending on their nature were found. The smallest changes in the blood system of hens were observed under the influence of the lack of food, namely an increase, within the physiological norm, the content of leukocytes and ESR, decreased hemoglobin, hematocrit, erythrocytes, platelets, as well as violation of the ratio of different forms of leukocytes – an increase in the concentration of heterophiles (3.3% > normal) on the background of a decrease in the concentration of monocytes (1.6% < normal), lymphocytes and basophils. Whereas under the influence of the factor of lack of light, a higher content of leukocytes in the blood by 10.6%, a lower concentration of hemoglobin by 22.4%, hematocrit – by 4.2%, platelets – by 9.8%, as well as higher erythrocyte sedimentation rate by 9.8%, higher concentration of heterophiles by 5.9% and lower concentration of lymphocytes – by 4.6%, compared with the lack of food. The most significant changes in the blood system were observed under the influence of a factor of significant overcrowding of hens, namely higher blood leukocytes by 17.1 and 5.9%, lower hemoglobin concentration by 29.6 and 9.2%, hematocrit – by 5.9 and 1.7%, erythrocytes – by 10.3%, platelets – by 35.8 and 28.8%, as well as higher erythrocyte sedimentation rate by 4.9%, higher concentration of heterophiles by 11.3 and 5.4% and lower concentration monocytes – by 0.8 and 0.4%, lymphocytes – by 9.4 and 4.8% and eosinophils – by 0.7%, compared with the factor of lack of food and lack of light, respectively.

A Clinical Case of Aplastic Anemia After COVID-19 Infection

Aplastic anemia is a rare disease of the blood system characterized by suppression of hematopoiesis in all lines of hematopoiesis, replacement of hematopoietic tissue with fatty tissue and absence of other causes or diseases that can suppress hematopoiesis. The incidence is 2-3 cases per 1 million population per year in the regions of Europe and America, rates are 2-3 times higher in East Asia. The disease most often begins between the ages of 10 and 25 years and over 60 years. The etiology remains unknown in 70-80 % of cases. The frequency of acquired cases predominates over congenital cases. The triggering factors can be chemical, physical exposures, medications, and viral infections. This case report describes a case of a patient developing aplastic anemia, as a result of a coronavirus infection.

The 4-Year Experience with Implementation and Routine Use of Pathogen Reduction in a Brazilian Hospital

(1) Background: We reviewed the logistics of the implementation of pathogen reduction (PR) using the INTERCEPT Blood System™ for platelets and the experience with routine use and clinical outcomes in the patient population at the Sírio-Libanês Hospital of São Paulo, Brazil. (2) Methods: Platelet concentrate (PC), including pathogen reduced (PR-PC) production, inventory management, discard rates, blood utilization, and clinical outcomes were analyzed over the 40 months before and after PR implementation. Age distribution and wastage rates were compared over the 10 months before and after approval for PR-PC to be stored for up to seven days. (3) Results: A 100% PR-PC inventory was achieved by increasing double apheresis collections and production of double doses using pools of two single apheresis units. Discard rates decreased from 6% to 3% after PR implementation and further decreased to 1.2% after seven-day storage extension for PR-PCs. The blood utilization remained stable, with no increase in component utilization. A significant decrease in adverse transfusion events was observed after the PR implementation. (4) Conclusion: Our experience demonstrates the feasibility for Brazilian blood centers to achieve a 100% PR-PC inventory. All patients at our hospital received PR-PC and showed no increase in blood component utilization and decreased rates of adverse transfusion reactions.

"Building a More Inclusive Blood System in Canada": A Mixed-Methods Evaluation of a Workshop to Guide Medical Students to Develop as Health Advocates Through Advancing Health Equity in Blood Product Donation for Gay, Bisexual, and Queer Men

Introduction: Competent and socially responsible physicians require a range of abilities other than medical expertise to effectively meet the healthcare needs of the people they serve, including health advocacy skills. The CanMEDS framework for physician competency outlines that, as Health Advocates, physicians work to determine and understand patient and community needs, speak on behalf of others when required, and support the mobilization of resources to effect change. Although recognized as essential for medical trainees to develop, health advocacy is challenging to teach and assess. Here, we describe the development and evaluation of a workshop to support Canadian medical students to develop as health advocates through advancing health equity in blood product donation for gay, bisexual, and other men who have sex with men (gbMSM) in Canada. Methods: We developed a workshop for a Canadian medical student audience, "Building a more inclusive blood system in Canada", consisting of an online module followed by a virtual facilitated discussion group. The online module (available at stemcellclub.ca/training) outlined blood and stem cell donation in Canada for gbMSM, starting from the historical policies and the context in which they were first put in place, to today's policies and where future policies may lie (Fig. A). The module also presented content from a national campaign in Canada to engage gbMSM as stem cell donors (stemcellclub.ca/savingliveswithpride). The discussion group supported participants to reflect on donation policies for gbMSM and their consequences, and discuss how medical students can concurrently advocate for gbMSM and patients in need of blood products. A facilitator guide was developed and facilitator training was provided. A pre- and post- test was administered to participants to assess knowledge transfer. Quantitative and qualitative analyses were employed to evaluate participants' perspectives on the impact of the workshop on their development as health advocates. Results: From 10/2020-7/2021, workshops were hosted at 8 medical schools across Canada. 104 medical students from across Canada participated, of whom 65 (63% response rate) completed a pre- and post- workshop survey. 26 (40%) of survey respondents were male, 22 (34%) identified as LGBTQ+ (10 gay, 9 bisexual, 3 other), and 52% were non-Caucasian (from 9 different ancestral groups). 44 (68%) were in the first and 16 (25%) in second years of medical school. Post-workshop, mean scores on a 6-question stem cell donation knowledge test improved from 33% to 79% (p&lt;0.001, Fig B), and 88% felt the workshop prepared them to discuss blood and stem cell donation for gbMSM with others. 98% strongly agreed/agreed the workshop supported their development as health advocates (Fig C), including the abilities to: advocate for patients beyond the clinical environment (83%); work with patients (88%) or communities and populations (74%) to address and identify determinants of health that affect them and their access to care; respond to the needs of communities or populations by advocating with them for system-level change (83%); improve clinical practice by applying a process of continuous quality improvement to disease prevention and health promotion activities (79%); and contribute to a process to improve the health of a community or population they will serve (90%). 94% felt that the workshop should be incorporated into medical curricula. 39 medical students participated in focus groups to share their perspectives on the workshop. (42% male, 37% LGBTQ+ identified, 76% non-Caucasian; 53% in first year of medical school). Qualitative analysis identified rich examples of participant development as health advocates through their participation in the workshop (Fig D). Conclusion: We present the perspective of a national cohort of medical students in Canada that their participation in a workshop on advancing health equity in blood product donation for gbMSM contributed to their development as health advocates. This workshop is a model for teaching health advocacy to medical students and is relevant to medical educators and curriculum developers. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare.

Emilia-Romagna Regional Blood System accreditation as an example of improvement through application of specific requirements: a retrospective analysis

BackgroundInstitutional accreditation in Italy represents the license given by a region to a public or private facility to provide services in the name and on behalf of the National Health Service. This study aims to evaluate the improvement of the Emilia-Romagna Regional Blood System and to highlight its unresolved issues, analysing non-conformities observed during accreditation and maintenance inspections between 2013 and 2018.MethodsAll the Emilia-Romagna Regional Blood facilities were invited to participate in this study voluntarily and anonymously. Participants had to access a web application that we developed specifically. For each of the three inspections evaluated in this study, they had to enter data about the state of their organisation branches and non-conformities observed by regional inspectors. All data entered were finally exported from the web application database and analysed with spreadsheets. Statistical analysis was performed using Wilcoxon signed-rank test with continuity correction.Results17 structures took part in the study, with a total of 174 organisation branches. The number of branches changed over the years because of new openings and closures due to reorganisations or non-conformities that were too difficult to correct. Inspectors observed 2381 non-conformities (291 structural, 611 technological and 1479 organisational). As a result of accreditation inspections and consequent improvement actions, non-conformities were reduced by 88%. The most frequent non-conformities concerned the management software and the transportation of blood and blood components.ConclusionAn improvement in the Emilia-Romagna Regional Blood System over time is evident: institutional accreditation certainly pushed it to change and overcome its problems to comply with specific requirements. The remaining non-conformities after the three inspections were mostly organisational and management software was the most critical issue. Despite these non-conformities, all currently active structures are accredited and guarantee high standards of quality and safety of products and services.

The 4-Year Experience with Implementation and Routine Use of Pathogen Inactivation in a Brazilian Hospital

(1) Background: We reviewed the logistics of the implementation of pathogen inactivation (PI) using the INTERCEPT Blood System&trade; for platelets and the experience with routine use and clinical outcomes in the patient population at the S&iacute;rio-Liban&ecirc;s Hospital of S&atilde;o Paulo, Brazil. (2) Methods: Platelet concentrate (PC), including pathogen reduced (PR-PC) production, inventory management, discard rates, blood utilization, and clinical outcomes were analyzed over the 40 months before and after PI implementation. Age distribution and wastage rates were compared over the 10 months before and after approval for PR-PC to be stored for up to 7 days. (3) Results: A 100% PR-PC inventory was achieved by increasing double apheresis collections and production of double doses using pools of two single apheresis units. Discard rates decreased from 6% to 3% after PI implementation and further decreased to 1.2% after 7-day storage extension for PR-PCs. The blood utilization remained stable, with no increase in component utilization. A significant decrease in adverse transfusion events was observed after the PI implementation. (4) Conclusion: Our experience demonstrates the feasibility for Brazilian blood centers to achieve a 100% PR-PC inventory. All patients at our hospital received PR-PC and showed no increase in blood component utilization and decreased rates of adverse transfusion reactions.

Interdisciplinary Pharmacoeconomic Study of Pharmacotherapy of Cupping of Drunk Forms of Alcohol Dependence: Clinical and Pharmacological, Organizational, Legal and Marketing Experiment

An interdisciplinary pharmacoeconomic study of pharmacotherapy for the relief of alcoholic dependence on the basis of experimental clinical and pharmacological, organizational, legal and marketing studies. The scheme of basic pharmacotherapy of relief of drunken forms of alcohol dependence developed by the authors for the interdisciplinary study was used. Thirteen international nonproprietary names of drugs from Ukrainian (92.3%) and foreign (7.7%) manufacturers were selected. It was established that for pharmacotherapy of support of relief of drunken forms of alcohol dependence tablets occupy 23,1% of appointments of doctors, solutions – 76,9%. The scheme of pharmacotherapy in the relief of intoxicated forms of alcohol dependence includes 38.5% of international nonproprietary names of drugs with ATC code "A" - drugs that affect the digestive system and metabolism; 30.7% with ATC code "B" - drugs that affect the blood system and hematopoiesis; 15.4% with ATC codes of classification "C" – drugs that affect the cardiovascular system and "N" – drugs that affect the nervous system. Nomenclature and legal analysis showed that 92.3% of the studied drugs belong to prescription nomenclature and legal group; the share of OTC drugs is 7.69% (international nonproprietary name Antral).

The effect of photobiomodulation therapy of some indices of rats’ blood cells functional state under experimental diabetes mellitus

Background. Diabetes mellitus is a chronic endocrine-metabolic disease caused by an absolute or relative insulin deficiency. During diabetes, there are perfect conditions for the development of oxidative stress: the content of substrates for oxidation increases, the content of natural antioxidants decreases and the activity of antioxidant systems is suppressed. It is known that photobiomodulation therapy produce antioxidant and antihyperglycemic effects. Here we investigated its influence on blood system functioning. Materials and Methods. The study was performed on male Wistar rats. Experimental diabetes mellitus was induced by the intraperitoneal injection of streptozotocin. Leukocyte formula was calculated using blood smears stained by Romanowsky–Giemsa. Catalase activity was determined spectrophotometrically. Affinity of hemoglobin to oxygen was evaluated by spectrophotometric method in Ivanov’s modification by drawing oxygenation curves. The protoporphyrin content in whole blood was measured by analyzing its fluorescence spectra. The content of NO2-, total and inducible NO synthase activity was determined spectrophotometrically. Results. Under the action of photobiomodulation therapy on healthy animals, there was a shift of oxygenation curves to the left and a decrease of P50, whereas under irradiation of rats with diabetes, there was a shift of oxygenation curves to the right and increase in P50 compared to indices in nonirradiated animals. During diabetes, there was a decrease in protoporphyrin content compared to control, but there was a tendency to increase under photobiomodulation. Photobiomodulation therapy of rats with diabetes increased catalase activity in erythrocyte hemolysates. We revealed significant changes in leukocyte formula under photobiomodulation. The total NO synthase activity in leukocytes of rats with diabetes was higher compared to healthy animals, but decreased under the action of photobiomodulation. We found an increase in inducible NO synthase activity in leukocytes of rats with diabetes and in leukocytes of irradiated healthy animals. An increase in NO2- content in leukocytes of rats with diabetes was detected. Under photobiomodulation, NO2- content was significantly lower in rats with diabetes. Conclusion. Photobiomodulation therapy produces a corrective action on blood system during diabetes, in particular, it improves oxygen release from hemoglobin and prevents hypoxia. Simultaneously with the increase in tissue oxygen saturation, a decrease in NO synthase activity and nitrite content along with an increase in catalase activity prevents the development of oxidative stress.