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He Y, Liang S, Xu Y, Wan C, Ma F, Wang B. The Analysis of the Effect of Blood Transfusion on Changes of Blood Platelet Parameters in Patients with Leukemia Treated with Chemotherapy. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:2901993. [PMID: 36072416 PMCID: PMC9444399 DOI: 10.1155/2022/2901993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 07/22/2022] [Accepted: 07/25/2022] [Indexed: 11/18/2022]
Abstract
Objective To study and analyze the effect of blood transfusion on the change of blood platelet parameters in patients with leukemia treated with chemotherapy. Methods Ninety-eight patients with leukemia treated with chemotherapy in the First Affiliated Hospital of Xi'an Jiaotong University from January 2021 to January 2022 were selected to observe the changes of platelet parameters before and after blood transfusion. Results There was significant difference between pre-transfusion and post-transfusion indexes (platelet count, mean platelet volume, and hematocrit) (P < 0.05). After binary logistic regression analysis, the use of antibiotics (OR = 2.235), blood transfusion history (OR = 3.086), abnormal white blood cell count (OR = 1.134), and frozen plasma transfusion (OR = 3.121) were the main factors of blood platelet parameters after transfusion in leukemia patients (P < 0.05). Conclusion Blood transfusion is beneficial to improve blood platelet parameters and prevent bleeding in patients with leukemia treated with chemotherapy. Attention should be paid to patients with risk factors for poor response to blood platelet transfusion and early intervention.
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Affiliation(s)
- Yangxin He
- Department of Blood Transfusion, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shannxi, China
| | - Shanshan Liang
- Department of Blood Transfusion, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shannxi, China
| | - Yali Xu
- Department of Blood Transfusion, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shannxi, China
| | - Chunjing Wan
- Department of Blood Transfusion, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shannxi, China
| | - Feng Ma
- Department of Blood Transfusion, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shannxi, China
| | - Baoyan Wang
- Department of Blood Transfusion, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an 710061, Shannxi, China
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Sullivan JC, Peña JR. Use of Human Leukocyte Antigen (HLA)-Incompatible Platelet Units in HLA Platelet-Refractory Patients With Limited Number of or Low-Level HLA Donor-Specific Antibodies Results in Permissive Transfusions. Arch Pathol Lab Med 2022; 146:1243-1251. [PMID: 35171984 DOI: 10.5858/arpa.2021-0051-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— In human leukocyte antigen (HLA)-mediated alloimmune platelet refractoriness, HLA-incompatible platelets may produce adequate posttransfusion corrected count increment ("permissive transfusion") and increase the donor pool. OBJECTIVE.— To determine if a lower number of or low-level anti-HLA donor-specific antibodies (DSAs) predict permissive transfusion and could be used to prioritize platelet selection. DESIGN.— We categorized platelets administered from 2016 to 2018 as HLA-compatible or HLA-incompatible based on presence of DSAs against the donor unit. We further divided HLA-incompatible units based on the number of DSAs and the level of DSAs (measured by mean fluorescence intensity [MFI]), where cumulative MFI ≥6000 defines high-level DSA. We compared posttransfusion corrected count increments (CCIs) and transfusion reactions among these transfusions. RESULTS.— Of 279 HLA-selected units transfused into 26 platelet-refractory patients, we resorted to using 39 HLA-incompatible units (14%). Posttransfusion CCI and transfusion reaction frequency were similar among units targeted by 1 or low-level DSAs and HLA-compatible units. Units targeted by ≥2 distinct or high-level DSAs produced lower CCIs. Regardless of ABO compatibility, similarly HLA-categorized units yielded comparable CCIs and comparable frequency of transfusion reactions. CONCLUSIONS.— HLA-incompatible platelets transfused across 1 or low-level DSAs were commonly permissive, whereas those transfused across ≥2 DSAs or high levels of DSA (MFI ≥6000) were nonpermissive. The use of such donor units offers transfusion services alternative platelet units for support of platelet-refractory patients.
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Affiliation(s)
- Jensyn Cone Sullivan
- From the Department of Pathology, Tufts Medical Center, Boston, Massachusetts (Sullivan)
| | - Jeremy Ryan Peña
- the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Peña)
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Chenna D, Shastry S, Baliga P. Evaluation and monitoring of response to platelet transfusion therapy: experience from a tertiary care center. Acta Clin Belg 2021; 76:300-303. [PMID: 32090713 DOI: 10.1080/17843286.2020.1732568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: Refractoriness to platelet transfusion is defined as Corrected Count Increment (CCI) <5000 after two sequential ABO identical transfusions. Immune causes include alloimmunization to HLA and/or platelet-specific antigens. Analysis of various factors leading to platelet refractoriness would help in the management of the patient in a timely manner.Materials and Methods: A prospective observational study on platelet transfusions from November 2013 to June 2015 was conducted. Demographic information, pre, and post-transfusion platelet counts and relevant clinical details were noted. Among patients who were considered refractory to platelet transfusions, platelet factor 3 assay was performed to detect antiplatelet antibodies. Data were analyzed using SPSS software. A P value of <0.05 was considered to be statistically significant.Results: A total of 1190 patients received platelet transfusions during the study period. Among these only 339 (28.5%) patients received transfusions on two or more occasions, of which 237 (69.91%) were considered non-refractory. Among the 102 (30.1%) refractory cases non-immune causes for refractoriness were present in 97 (95.1%) patients and antiplatelet antibody was positive in 18 (17.64%) patients. Bleeding and medication have shown to have significantly contributed to refractoriness (p = 0.025 and 0.003) respectively. Use of medication was independently associated with refractoriness.Conclusion: Non-immune causes are more profound in leading to a poor response to platelet transfusions. Recognizing the cause of poor response and treating the underlying cause would help in getting a better response.
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Affiliation(s)
- Deepika Chenna
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Shamee Shastry
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Poornima Baliga
- Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
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Sung AD, Yen RC, Jiao Y, Bernanke A, Lewis DA, Miller SE, Li Z, Ross JR, Artica A, Piryani S, Zhou D, Liu Y, Vo-Dinh T, Hoffman M, Ortel TL, Chao NJ, Chen BJ. Fibrinogen-Coated Albumin Nanospheres Prevent Thrombocytopenia-Related Bleeding. Radiat Res 2020; 194:162-172. [PMID: 32845987 DOI: 10.1667/rade-20-00016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 05/07/2020] [Indexed: 11/03/2022]
Abstract
Thrombocytopenia (TCP) may cause severe and life-threatening bleeding. While this may be prevented by platelet transfusions, transfusions are associated with potential complications, do not always work (platelet refractory) and are not always available. There is an urgent need for a synthetic alternative. We evaluated the ability of fibrinogen-coated nanospheres (FCNs) to prevent TCP-related bleeding. FCNs are made of human albumin polymerized into a 100-nm sphere and coated with fibrinogen. We hypothesized that FCNs would bind to platelets through fibrinogen-GPIIb/IIIa interactions, contributing to hemostasis in the setting of TCP. We used two murine models to test these effects: in the first model, BALB/c mice received 7.25 Gy total-body irradiation (TBI); in the second model, lower dose TBI (7.0 Gy) was combined with an anti-platelet antibody (anti-CD41) to induce severe TCP. Deaths in both models were due to gastrointestinal or intracranial bleeding. Addition of antiplatelet antibody to 7.0 Gy TBI significantly worsened TCP and increased mortality compared to 7.0 Gy TBI alone. FCNs significantly improved survival compared to saline control in both models, suggesting it ameliorated TCP-related bleeding. Additionally, in a saphenous vein bleeding model of antibody-induced TCP, FCNs shortened bleeding times. There were no clinical or histological findings of thrombosis or laboratory findings of disseminated intravascular coagulation after FCN treatment. In support of safety, fluorescence microscopy suggests that FCNs bind to platelets only upon platelet activation with collagen, limiting activity to areas of endothelial damage. To our knowledge, this is the first biosynthetic agent to demonstrate a survival advantage in TCP-related bleeding.
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Affiliation(s)
- Anthony D Sung
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, and Duke Cancer Institute
| | | | - Yiqun Jiao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, and Duke Cancer Institute
| | | | | | | | - Zhiguo Li
- Department of Biostatistics & Bioinformatics
| | - Joel R Ross
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, and Duke Cancer Institute
| | - Alexandra Artica
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, and Duke Cancer Institute
| | - Sadhna Piryani
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, and Duke Cancer Institute
| | - Dunhua Zhou
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, and Duke Cancer Institute
| | - Yang Liu
- Department of Biomedical Engineering, Pratt School of Engineering
| | - Tuan Vo-Dinh
- Department of Biomedical Engineering, Pratt School of Engineering.,Department of Chemistry, Duke University, Durham, North Carolina
| | | | - Thomas L Ortel
- Division of Hematology, Department of Medicine.,Department of Pathology
| | - Nelson J Chao
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, and Duke Cancer Institute
| | - Benny J Chen
- Division of Hematologic Malignancies and Cellular Therapy, Department of Medicine, and Duke Cancer Institute
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Chavan A, Sharma RR, Saikia B, Malhotra P, Prakash S, Hans R, Marwaha N. Efficacy of cross-match compatible platelets in multi transfused haemato-oncology patients refractory to platelet transfusion. Transfus Apher Sci 2019; 58:102657. [PMID: 31706911 DOI: 10.1016/j.transci.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/12/2019] [Accepted: 09/18/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Platelet refractoriness, which leads to platelet transfusion failure resulting in significant morbidity and long hospital stay, is routinely not investigated. AIMS To determine the efficacy of cross-match compatible platelets in multi-transfused alloimmunized hemato-oncological patients refractory to platelet transfusion. MATERIALS AND METHOD 149 ABO compatible single donor apheresis platelet transfusions given to 38 alloimmunized refractory patients. Corrected Count Increment (CCI) <5000 (1 h) was taken to define refractoriness. Solid-phase red cell adherence assay was used to determine the alloimmunization status and platelet cross-matching. Post Transfusion Platelet Increment, CCI and the Percentage Platelet Recovery were used to monitor the effectiveness of platelet transfusion. ANOVA test followed by Post hoc test Tukey HSD used to compare group means and classified into three groups depending upon the cross-matching and compatibility status. Categorical data was analysed for various outcomes using Pearson's chi square test or Fischer exact test. RESULT Patients showed statistically significant recovery in terms of PPI, CCI and PPR at 1 h post SDAP transfusions when they received cross-matched compatible platelets. The one-hour CCI was significantly higher for cross-match-compatible platelets (19173 ± 2692) than for incompatible (5888 ± 1526) and for uncross-matched (8140 ± 1480). Forty four (97.8%) of 45 cross-matched compatible platelet transfusion episodes showed a satisfactory response in terms of PPI and CCI values as compared to 50 % and 53.9% in uncross-matched group respectively (p < 0.0001). CONCLUSION Platelet cross-matching is an effective intervention in the management of multi-transfused alloimmunized Haemato-oncological patients, refractory to platelet transfusion.
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Affiliation(s)
- Anjali Chavan
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ratti Ram Sharma
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
| | - Biman Saikia
- Department of Immunopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pankaj Malhotra
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Satya Prakash
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Rekha Hans
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Neelam Marwaha
- Department of Transfusion Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Mangwana S, Kacker A, Simon N. Platelet compatibility and platelet antibodies detection: A step towards resolving dilemma in management of platelet refractoriness in oncology patients. GLOBAL JOURNAL OF TRANSFUSION MEDICINE 2019. [DOI: 10.4103/gjtm.gjtm_51_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rajadhyaksha BS, Desai DP, Navkudkar AA. Platelet refractoriness. GLOBAL JOURNAL OF TRANSFUSION MEDICINE 2019. [DOI: 10.4103/gjtm.gjtm_45_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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