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Nemkov T, Stephenson D, Earley EJ, Keele GR, Hay A, Key A, Haiman Z, Erickson C, Dzieciatkowska M, Reisz JA, Moore A, Stone M, Deng X, Kleinman S, Spitalnik SL, Hod EA, Hudson KE, Hansen KC, Palsson BO, Churchill GA, Roubinian N, Norris PJ, Busch MP, Zimring JC, Page GP, D'Alessandro A. Biological and Genetic Determinants of Glycolysis: Phosphofructokinase Isoforms Boost Energy Status of Stored Red Blood Cells and Transfusion Outcomes. bioRxiv 2024:2023.09.11.557250. [PMID: 38260479 PMCID: PMC10802247 DOI: 10.1101/2023.09.11.557250] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
Mature red blood cells (RBCs) lack mitochondria, and thus exclusively rely on glycolysis to generate adenosine triphosphate (ATP) during aging in vivo and during storage in vitro in the blood bank. Here we identify an association between blood donor age, sex, ethnicity and end-of-storage levels of glycolytic metabolites in 13,029 volunteers from the Recipient Epidemiology and Donor Evaluation Study. Associations were also observed to ancestry-specific genetic polymorphisms in regions encoding phosphofructokinase 1, platelet (which we detected in mature RBCs), hexokinase 1, and ADP-ribosyl cyclase 1 and 2 (CD38/BST1). Gene-metabolite associations were validated in fresh and stored RBCs from 525 Diversity Outbred mice, and via multi-omics characterization of 1,929 samples from 643 human RBC units during storage. ATP levels, breakdown, and deamination into hypoxanthine were associated with hemolysis in vitro and in vivo, both in healthy autologous transfusion recipients and in 5,816 critically ill patients receiving heterologous transfusions. Highlights Blood donor age and sex affect glycolysis in stored RBCs from 13,029 volunteers;Ancestry, genetic polymorphisms in PFKP, HK1, CD38/BST1 influence RBC glycolysis;RBC PFKP boosts glycolytic fluxes when ATP is low, such as in stored RBCs;ATP and hypoxanthine are biomarkers of hemolysis in vitro and in vivo. Graphical abstract
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Stone M, Spencer BR, Warden DE, Fink RV, Saa P, Leddy J, Mulach-Vannoy J, Townsend R, Krysztof D, Hughes AN, Di Germanio C, Kessler DA, Kleinman S, Busch MP, Norris PJ. Patient and immunological factors associated with delayed clearance of mucosal SARS-CoV-2 RNA and symptom persistence. J Infect Dis 2024:jiae132. [PMID: 38470857 DOI: 10.1093/infdis/jiae132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/01/2024] [Accepted: 03/07/2024] [Indexed: 03/14/2024] Open
Abstract
Serial blood and mucosal samples were characterized for 102 participants enrolled a median of 7.0 days post-COVID-19 diagnosis. Mucosal RNA was detectable a median 31.5 (95% CI 20.5 - 63.5) days, with persistence ≥1 month associated with obesity (BMI ≥30, OR 3.9, 95% CI 1.2 - 13.8) but not age, sex, or chronic conditions. Fifteen participants had likely reinfection; lower serum anti-S IgG levels were associated with reinfection risk. Nearly half of participants (47%) reported symptoms lasting ≥2-3 months; persistence ≥3 months was associated with BMI ≥30 (OR = 4.2 95% CI 1.1 - 12.8) and peak anti-S and anti-NC antibody levels.
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Affiliation(s)
- Mars Stone
- Vitalant Research Institute, San Francisco, California, USA
- Departments of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Bryan R Spencer
- Scientific Affairs, American Red Cross, Rockville, Maryland, USA
| | | | | | - Paula Saa
- Scientific Affairs, American Red Cross, Rockville, Maryland, USA
| | - Jennifer Leddy
- Vitalant Research Institute, San Francisco, California, USA
| | | | - Rebecca Townsend
- Scientific Affairs, American Red Cross, Rockville, Maryland, USA
| | - David Krysztof
- Scientific Affairs, American Red Cross, Rockville, Maryland, USA
| | | | - Clara Di Germanio
- Vitalant Research Institute, San Francisco, California, USA
- Departments of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | | | - Steven Kleinman
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, California, USA
- Departments of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
| | - Philip J Norris
- Vitalant Research Institute, San Francisco, California, USA
- Departments of Laboratory Medicine, University of California San Francisco, San Francisco, California, USA
- Departments of Medicine, University of California San Francisco, San Francisco, California, USA
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Mahmoud R, Arbel S, Ianculovici C, Peleg O, Kleinman S, Shuster A. Antimicrobial therapy in the management of odontogenic infections: the penicillin-allergic patient. Int J Oral Maxillofac Surg 2024; 53:251-257. [PMID: 37758642 DOI: 10.1016/j.ijom.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/12/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023]
Abstract
This retrospective analysis was performed to investigate whether clindamycin remains the preferred antibiotic for penicillin-allergic patients with odontogenic infections. The medical records of 311 patients admitted to the study department with odontogenic infections between 2018 and 2022 and treated with either intravenous amoxicillin-clavulanic acid (Augmentin) or intravenous clindamycin were analyzed. The Augmentin-treated group included 268 patients (86.2%) and the clindamycin-treated group included 43 patients (13.8%). Severity parameters did not differ significantly between the two groups, except for a higher prevalence of abscesses in the clindamycin-treated group (58.1% vs 41.0% in the Augmentin-treated group; P = 0.035). The clindamycin-treated group required a longer duration of intravenous antibiotics (P = 0.001) and had a higher rate of treatment failure (14.0% vs 2.2%; P = 0.002) when compared to the Augmentin-treated group, with a seven-fold increased risk of treatment failure. Moreover, significantly more isolated organisms in the clindamycin-treated group were resistant to clindamycin (P = 0.015); these were all Streptococcus anginosus group. Given the higher risk of treatment failure with clindamycin, it is necessary to choose the antibiotic treatment for penicillin-allergic patients carefully. A detailed history and allergy testing followed by combination therapy is recommended, especially in severe cases.
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Affiliation(s)
- R Mahmoud
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - S Arbel
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - C Ianculovici
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - O Peleg
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S Kleinman
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Shuster
- Department of Oral and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Oral and Maxillofacial Surgery, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Nemkov T, Stephenson D, Erickson C, Dzieciatkowska M, Key A, Moore A, Earley EJ, Page GP, Lacroix IS, Stone M, Deng X, Raife T, Kleinman S, Zimring JC, Roubinian N, Hansen KC, Busch MP, Norris PJ, D’Alessandro A. Regulation of kynurenine metabolism by blood donor genetics and biology impacts red cell hemolysis in vitro and in vivo. Blood 2024; 143:456-472. [PMID: 37976448 PMCID: PMC10862365 DOI: 10.1182/blood.2023022052] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 10/26/2023] [Accepted: 11/04/2023] [Indexed: 11/19/2023] Open
Abstract
ABSTRACT In the field of transfusion medicine, the clinical relevance of the metabolic markers of the red blood cell (RBC) storage lesion is incompletely understood. Here, we performed metabolomics of RBC units from 643 donors enrolled in the Recipient Epidemiology and Donor Evaluation Study, REDS RBC Omics. These units were tested on storage days 10, 23, and 42 for a total of 1929 samples and also characterized for end-of-storage hemolytic propensity after oxidative and osmotic insults. Our results indicate that the metabolic markers of the storage lesion poorly correlated with hemolytic propensity. In contrast, kynurenine was not affected by storage duration and was identified as the top predictor of osmotic fragility. RBC kynurenine levels were affected by donor age and body mass index and were reproducible within the same donor across multiple donations from 2 to 12 months apart. To delve into the genetic underpinnings of kynurenine levels in stored RBCs, we thus tested kynurenine levels in stored RBCs on day 42 from 13 091 donors from the REDS RBC Omics study, a population that was also genotyped for 879 000 single nucleotide polymorphisms. Through a metabolite quantitative trait loci analysis, we identified polymorphisms in SLC7A5, ATXN2, and a series of rate-limiting enzymes (eg, kynurenine monooxygenase, indoleamine 2,3-dioxygenase, and tryptophan dioxygenase) in the kynurenine pathway as critical factors affecting RBC kynurenine levels. By interrogating a donor-recipient linkage vein-to-vein database, we then report that SLC7A5 polymorphisms are also associated with changes in hemoglobin and bilirubin levels, suggestive of in vivo hemolysis in 4470 individuals who were critically ill and receiving single-unit transfusions.
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Affiliation(s)
- Travis Nemkov
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO
- Omix Technologies Inc, Aurora, CO
| | - Daniel Stephenson
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO
| | - Christopher Erickson
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO
| | - Monika Dzieciatkowska
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO
| | - Alicia Key
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO
| | - Amy Moore
- Research Triangle Institute International, Atlanta, GA
| | | | - Grier P. Page
- Research Triangle Institute International, Atlanta, GA
| | - Ian S. Lacroix
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO
| | - Mars Stone
- Vitalant Research Institute, San Francisco, CA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Xutao Deng
- Vitalant Research Institute, San Francisco, CA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Thomas Raife
- Department of Pathology and Laboratory Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Steven Kleinman
- Department of Pathology, University of British Columbia, Victoria, BC, Canada
| | - James C. Zimring
- Department of Pathology, University of Virginia, Charlottesville, VA
| | - Nareg Roubinian
- Vitalant Research Institute, San Francisco, CA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
- Kaiser Permanente Northern California Division of Research, Oakland, CA
| | - Kirk C. Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO
| | - Michael P. Busch
- Vitalant Research Institute, San Francisco, CA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Philip J. Norris
- Vitalant Research Institute, San Francisco, CA
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, CA
| | - Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, CO
- Omix Technologies Inc, Aurora, CO
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D’Alessandro A, Earley EJ, Nemkov T, Stephenson D, Dzieciatkowska M, Hansen KC, Minetti G, Champigneulle B, Stauffer E, Pichon A, Furian M, Verges S, Kleinman S, Norris PJ, Busch MP, Page GP, Kaestner L. Genetic polymorphisms and expression of Rhesus blood group RHCE are associated with 2,3-bisphosphoglycerate in humans at high altitude. Proc Natl Acad Sci U S A 2024; 121:e2315930120. [PMID: 38147558 PMCID: PMC10769835 DOI: 10.1073/pnas.2315930120] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 10/24/2023] [Indexed: 12/28/2023] Open
Abstract
Red blood cell (RBC) metabolic reprogramming upon exposure to high altitude contributes to physiological human adaptations to hypoxia, a multifaceted process critical to health and disease. To delve into the molecular underpinnings of this phenomenon, first, we performed a multi-omics analysis of RBCs from six lowlanders after exposure to high-altitude hypoxia, with longitudinal sampling at baseline, upon ascent to 5,100 m and descent to sea level. Results highlighted an association between erythrocyte levels of 2,3-bisphosphoglycerate (BPG), an allosteric regulator of hemoglobin that favors oxygen off-loading in the face of hypoxia, and expression levels of the Rhesus blood group RHCE protein. We then expanded on these findings by measuring BPG in RBCs from 13,091 blood donors from the Recipient Epidemiology and Donor Evaluation Study. These data informed a genome-wide association study using BPG levels as a quantitative trait, which identified genetic polymorphisms in the region coding for the Rhesus blood group RHCE as critical determinants of BPG levels in erythrocytes from healthy human volunteers. Mechanistically, we suggest that the Rh group complex, which participates in the exchange of ammonium with the extracellular compartment, may contribute to intracellular alkalinization, thus favoring BPG mutase activity.
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Affiliation(s)
- Angelo D’Alessandro
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus,Aurora, CO80045
| | - Eric J. Earley
- Research Triangle Institute International, Atlanta, GA30329-4434
| | - Travis Nemkov
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus,Aurora, CO80045
| | - Daniel Stephenson
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus,Aurora, CO80045
| | - Monika Dzieciatkowska
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus,Aurora, CO80045
| | - Kirk C. Hansen
- Department of Biochemistry and Molecular Genetics, University of Colorado Anschutz Medical Campus,Aurora, CO80045
| | - Giampaolo Minetti
- Department of Biology and Biotechnology, University of Pavia, Pavia27100, Italy
| | - Benoit Champigneulle
- Hypoxia Physiopathology laboratory (HP2), INSERM U1042, Grenoble Alpes University, Grenoble38400, France
| | - Emeric Stauffer
- Laboratoire Interuniversitaire de Biologie de la Motricité (LIBM) EA7424, Université Claude Bernard Lyon 1, Lyon69100, France
| | - Aurélien Pichon
- Université de Poitiers, Laboratoire MOVE,Poitiers20296, France
| | - Michael Furian
- Pulmonology Department, University of Zurich, Zürich 1008091, Switzerland
| | - Samuel Verges
- Hypoxia Physiopathology laboratory (HP2), INSERM U1042, Grenoble Alpes University, Grenoble38400, France
| | - Steven Kleinman
- Department of Pathology and Laborarory Medicine, University of British Columbia, Victoria, BC V6T 1Z4, Canada
| | | | | | - Grier P. Page
- Research Triangle Institute International, Atlanta, GA30329-4434
| | - Lars Kaestner
- Dynamics of Fluids, Experimental Physics, Saarland University, Saarbrücken66123, Germany
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Lelie N, Busch M, Kleinman S. Efficacy of Different Testing Scenarios in Reducing Transfusion-Transmitted Hepatitis B Virus (TT-HBV) Infection Risk. Viruses 2022; 14:v14102263. [PMID: 36298818 PMCID: PMC9609221 DOI: 10.3390/v14102263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/11/2022] [Accepted: 10/12/2022] [Indexed: 11/29/2022] Open
Abstract
The efficacy of different screening scenarios in reducing hepatitis B virus (HBV) transmission risk as compared to the risk without screening was modeled in 9,337,110 donations from four geographical regions that had been subjected to hepatitis B surface antigen (HBsAg) and individual donation nucleic acid amplification testing (ID-NAT). We used the Weusten models for estimating infectivity risk for Red Blood Cell (RBC) transfusions in eight HBV infection stages and then evaluated multiple screening strategies based on minipool (MP) and ID-NAT options of different sensitivity for their efficacy in reducing this risk. The efficacy in reducing HBV transmission risk by screening scenarios across the regions varied between 81% (HBsAg only) and 99.2% (ID-NAT and anti-HBc). Highly sensitive ID-NAT alone achieved a slightly higher risk reduction (97.6−99.0%) than minipool of 6 donations (MP6)-NAT in combination with HBsAg and anti-HBc (96.3−98.7%). In ID-NAT screened lapsed and repeat donors, the additional risk removed by HBsAg testing was minimal (<0.1%). The modeling outcomes in this and two previous reports using this multi-regional database suggest that one could consider an ID-NAT alone testing scenario as an alternative to MP-NAT and serology-based testing algorithms and restrict serologic testing to first-time donors only.
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Affiliation(s)
- Nico Lelie
- Lelie Research, 1811 DK Alkmaar, The Netherlands
- Correspondence:
| | - Michael Busch
- Vitalant Research Institute, San Francisco, CA 94105, USA
| | - Steven Kleinman
- Department of Pathology, University of British Columbia, Victoria, BC V6T 1Z4, Canada
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Mahmoud R, Arbel S, Shuster A, Ianculovici C, Peleg O, Kleinman S. Intraoperative blood loss and the need for preoperative blood preparations in transgender women undergoing facial feminization surgeries: implications for surgeons. Int J Oral Maxillofac Surg 2022; 52:72-78. [PMID: 35717281 DOI: 10.1016/j.ijom.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 05/19/2022] [Accepted: 05/20/2022] [Indexed: 11/29/2022]
Abstract
The aim of this retrospective study was to assess blood loss during facial feminization surgeries and to evaluate blood transfusion requirements. Data from the medical records of all male-to-female transgender patients (transwomen) treated with gender affirming hormones and undergoing facial feminization surgeries were analysed. The total blood loss was calculated based on the haemoglobin balanced method. Twenty transwomen (average age of 25.9 years) were enrolled. Group 1 included 10 transwomen who underwent cranioplasty, genioplasty, and mandibular angles refining, group 2 included six transwomen who underwent cranioplasty and genioplasty, and group 3 included four transwomen who underwent mandibular angles refining and genioplasty. The median calculated blood loss for groups 1, 2, and 3 was 1159.7 ml, 828.5 ml, and 546.2 ml, respectively. The group differences in surgical time, intraoperative fluid amounts, and calculated blood loss volumes were significant. None of the patients required an intraoperative blood transfusion and the hormonal treatment had no effect on the amount of calculated blood loss. Hence, blood loss during facial feminization surgeries is well controlled and does not lead to life-threatening events, precluding the possibility of providing generalized recommendations for preoperative blood transfusion preparations.
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Affiliation(s)
- R Mahmoud
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel.
| | - S Arbel
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Shuster
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Oral and Maxillofacial Surgery, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - C Ianculovici
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - O Peleg
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S Kleinman
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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Stone M, Di Germanio C, Wright DJ, Sulaeman H, Dave H, Fink RV, Notari EP, Green V, Strauss D, Kessler D, Destree M, Saa P, Williamson PC, Simmons G, Stramer SL, Opsomer J, Jones JM, Kleinman S, Busch MP. Use of US Blood Donors for National Serosurveillance of Severe Acute Respiratory Syndrome Coronavirus 2 Antibodies: Basis for an Expanded National Donor Serosurveillance Program. Clin Infect Dis 2022; 74:871-881. [PMID: 34111244 PMCID: PMC8406874 DOI: 10.1093/cid/ciab537] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The Recipient Epidemiology and Donor Evaluation Study-IV-Pediatric (REDS-IV-P) Epidemiology, Surveillance and Preparedness of the Novel SARS-CoV-2 Epidemic (RESPONSE) seroprevalence study conducted monthly cross-sectional testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibodies in blood donors in 6 US metropolitan regions to estimate the extent of SARS-CoV-2 infections over time. METHODS During March-August 2020, approximately ≥1000 serum specimens were collected monthly from each region and tested for SARS-CoV-2 antibodies using a well-validated algorithm. Regional seroprevalence estimates were weighted based on demographic differences compared with the general population. Seroprevalence was compared with reported coronavirus disease 2019 (COVID-19) case rates over time. RESULTS For all regions, seroprevalence was <1.0% in March 2020. New York, New York, experienced the biggest increase (peak seroprevalence, 15.8% in May). All other regions experienced modest increases in seroprevalence (1%-2% in May-June to 2%-4% in July-August). Seroprevalence was higher in younger, non-Hispanic black, and Hispanic donors. Temporal increases in donor seroprevalence correlated with reported case rates in each region. In August, 1.3-5.6 estimated cumulative infections (based on seroprevalence data) per COVID-19 case were reported to the Centers for Disease Control and Prevention. CONCLUSIONS Increases in seroprevalence were found in all regions, with the largest increase in New York. Seroprevalence was higher in non-Hispanic black and Hispanic than in non-Hispanic white blood donors. SARS-CoV-2 antibody testing of blood donor samples can be used to estimate the seroprevalence in the general population by region and demographic group. The methods derived from the RESPONSE seroprevalence study served as the basis for expanding SARS-CoV-2 seroprevalence surveillance to all 50 states and Puerto Rico.
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Affiliation(s)
- Mars Stone
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California, San Francisco, California, USA
| | | | | | - Hasan Sulaeman
- Vitalant Research Institute, San Francisco, California, USA
| | - Honey Dave
- Vitalant Research Institute, San Francisco, California, USA
| | | | | | | | | | | | | | - Paula Saa
- American Red Cross, Gaithersburg, Maryland, USA
| | - Phillip C Williamson
- Vitalant Research Institute, San Francisco, California, USA
- Creative Testing Solutions, Tempe, Arizona, USA
| | - Graham Simmons
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California, San Francisco, California, USA
| | | | | | - Jefferson M Jones
- Centers for Disease Control and Prevention COVID-19 Response Team, Atlanta, Georgia, USA
| | - Steven Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
| | - Michael P Busch
- Vitalant Research Institute, San Francisco, California, USA
- Department of Laboratory Medicine, University of California, San Francisco, California, USA
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Jones JM, Stone M, Sulaeman H, Fink RV, Dave H, Levy ME, Di Germanio C, Green V, Notari E, Saa P, Biggerstaff BJ, Strauss D, Kessler D, Vassallo R, Reik R, Rossmann S, Destree M, Nguyen KA, Sayers M, Lough C, Bougie DW, Ritter M, Latoni G, Weales B, Sime S, Gorlin J, Brown NE, Gould CV, Berney K, Benoit TJ, Miller MJ, Freeman D, Kartik D, Fry AM, Azziz-Baumgartner E, Hall AJ, MacNeil A, Gundlapalli AV, Basavaraju SV, Gerber SI, Patton ME, Custer B, Williamson P, Simmons G, Thornburg NJ, Kleinman S, Stramer SL, Opsomer J, Busch MP. Estimated US Infection- and Vaccine-Induced SARS-CoV-2 Seroprevalence Based on Blood Donations, July 2020-May 2021. JAMA 2021; 326:1400-1409. [PMID: 34473201 PMCID: PMC8414359 DOI: 10.1001/jama.2021.15161] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
IMPORTANCE People who have been infected with or vaccinated against SARS-CoV-2 have reduced risk of subsequent infection, but the proportion of people in the US with SARS-CoV-2 antibodies from infection or vaccination is uncertain. OBJECTIVE To estimate trends in SARS-CoV-2 seroprevalence related to infection and vaccination in the US population. DESIGN, SETTING, AND PARTICIPANTS In a repeated cross-sectional study conducted each month during July 2020 through May 2021, 17 blood collection organizations with blood donations from all 50 US states; Washington, DC; and Puerto Rico were organized into 66 study-specific regions, representing a catchment of 74% of the US population. For each study region, specimens from a median of approximately 2000 blood donors were selected and tested each month; a total of 1 594 363 specimens were initially selected and tested. The final date of blood donation collection was May 31, 2021. EXPOSURE Calendar time. MAIN OUTCOMES AND MEASURES Proportion of persons with detectable SARS-CoV-2 spike and nucleocapsid antibodies. Seroprevalence was weighted for demographic differences between the blood donor sample and general population. Infection-induced seroprevalence was defined as the prevalence of the population with both spike and nucleocapsid antibodies. Combined infection- and vaccination-induced seroprevalence was defined as the prevalence of the population with spike antibodies. The seroprevalence estimates were compared with cumulative COVID-19 case report incidence rates. RESULTS Among 1 443 519 specimens included, 733 052 (50.8%) were from women, 174 842 (12.1%) were from persons aged 16 to 29 years, 292 258 (20.2%) were from persons aged 65 years and older, 36 654 (2.5%) were from non-Hispanic Black persons, and 88 773 (6.1%) were from Hispanic persons. The overall infection-induced SARS-CoV-2 seroprevalence estimate increased from 3.5% (95% CI, 3.2%-3.8%) in July 2020 to 20.2% (95% CI, 19.9%-20.6%) in May 2021; the combined infection- and vaccination-induced seroprevalence estimate in May 2021 was 83.3% (95% CI, 82.9%-83.7%). By May 2021, 2.1 SARS-CoV-2 infections (95% CI, 2.0-2.1) per reported COVID-19 case were estimated to have occurred. CONCLUSIONS AND RELEVANCE Based on a sample of blood donations in the US from July 2020 through May 2021, vaccine- and infection-induced SARS-CoV-2 seroprevalence increased over time and varied by age, race and ethnicity, and geographic region. Despite weighting to adjust for demographic differences, these findings from a national sample of blood donors may not be representative of the entire US population.
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Affiliation(s)
- Jefferson M. Jones
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mars Stone
- Vitalant Research Institute, San Francisco, California
| | | | | | - Honey Dave
- Vitalant Research Institute, San Francisco, California
| | | | | | | | - Edward Notari
- Scientific Affairs, American Red Cross, Rockville, Maryland
| | - Paula Saa
- Scientific Affairs, American Red Cross, Gaithersburg, Maryland
| | - Brad J. Biggerstaff
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | | | | | | - Chris Lough
- LifeSouth Community Blood Centers, Gainesville, Florida
| | | | | | - Gerardo Latoni
- Banco de Sangre de Servicios Mutuos, San Juan, Puerto Rico
| | | | | | - Jed Gorlin
- Innovative Blood Resources, St Paul, Minnesota
| | - Nicole E. Brown
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Carolyn V. Gould
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kevin Berney
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tina J. Benoit
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Maureen J. Miller
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Alicia M. Fry
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Aron J. Hall
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adam MacNeil
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Adi V. Gundlapalli
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sridhar V. Basavaraju
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan I. Gerber
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Monica E. Patton
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Brian Custer
- Vitalant Research Institute, San Francisco, California
| | | | | | - Natalie J. Thornburg
- COVID-19 Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Steven Kleinman
- University of British Columbia, Vancouver, British Columbia, Canada
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Kaplan I, Klein J, Shuster A, Chacham M, Ianculovici C, Peleg O, Rachima H, Kleinman S. CLINICOPATHOLOGIC ANALYSIS OF MINOR SALIVARY GLAND BIOPSIES FROM PATIENTS WITH XEROSTOMIA—HAS IGG4-RELATED DISEASE BEEN MISSED? Oral Surg Oral Med Oral Pathol Oral Radiol 2021. [DOI: 10.1016/j.oooo.2021.03.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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11
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D'Alessandro A, Fu X, Kanias T, Reisz JA, Culp-Hill R, Guo Y, Gladwin MT, Page G, Kleinman S, Lanteri M, Stone M, Busch MP, Zimring JC. Donor sex, age and ethnicity impact stored red blood cell antioxidant metabolism through mechanisms in part explained by glucose 6-phosphate dehydrogenase levels and activity. Haematologica 2021; 106:1290-1302. [PMID: 32241843 PMCID: PMC8094095 DOI: 10.3324/haematol.2020.246603] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Indexed: 12/15/2022] Open
Abstract
Red blood cell storage in the blood bank promotes the progressive accumulation of metabolic alterations that may ultimately impact the erythrocyte capacity to cope with oxidant stressors. However, the metabolic underpinnings of the capacity of RBCs to resist oxidant stress and the potential impact of donor biology on this phenotype are not known. Within the framework of the REDS-III RBC-Omics study, RBCs from 8,502 healthy blood donors were stored for 42 days and tested for their propensity to hemolyze following oxidant stress. A subset of extreme hemolyzers donated a second unit of blood, which was stored for 10, 23, and 42 days and profiled again for oxidative hemolysis and metabolomics (599 samples). Alterations of RBC energy and redox homeostasis were noted in donors with high oxidative hemolysis. RBCs from females, donors over 60 years old, donors of Asian/South Asian race-ethnicity, and RBCs stored in additive solution-3 were each independently characterized by improved antioxidant metabolism compared to, respectively, males, donors under 30 years old, Hispanic and African American race ethnicity donors, and RBCs stored in additive solution-1. Merging metabolomics data with results from an independent GWAS study on the same cohort, we identified metabolic markers of hemolysis and G6PD-deficiency, which were associated with extremes in oxidative hemolysis and dysregulation in NADPH and glutathione-dependent detoxification pathways of oxidized lipids. Donor sex, age, ethnicity, additive solution and G6PD status impact the metabolism of the stored erythrocyte and its susceptibility to hemolysis following oxidative insults.
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Affiliation(s)
| | - Xiaoyun Fu
- Bloodworks Northwest Research Institute, Seattle, WA, USA
| | | | - Julie A Reisz
- University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | - Rachel Culp-Hill
- University of Colorado Denver, Anschutz Medical Campus, Aurora, CO, USA
| | | | - Mark T Gladwin
- University of Pittsburgh Medical Center, Pittsburgh PA, USA
| | | | | | | | - Mars Stone
- Vitalant Research Institute, San Francisco, CA, USA
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12
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Thomas T, Cendali F, Fu X, Gamboni F, Morrison EJ, Beirne J, Nemkov T, Antonelou MH, Kriebardis A, Welsby I, Hay A, Dziewulska KH, Busch MP, Kleinman S, Buehler PW, Spitalnik SL, Zimring JC, D'Alessandro A. Fatty acid desaturase activity in mature red blood cells and implications for blood storage quality. Transfusion 2021; 61:1867-1883. [PMID: 33904180 DOI: 10.1111/trf.16402] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/24/2021] [Accepted: 03/30/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND Increases in the red blood cell (RBC) degree of fatty acid desaturation are reported in response to exercise, aging, or diseases associated with systemic oxidant stress. However, no studies have focused on the presence and activity of fatty acid desaturases (FADS) in the mature RBC. STUDY DESIGN AND METHODS Steady state metabolomics and isotope-labeled tracing experiments, immunofluorescence approaches, and pharmacological interventions were used to determine the degree of fatty acid unsaturation, FADS activity as a function of storage, oxidant stress, and G6PD deficiency in human and mouse RBCs. RESULTS In 250 blood units from the REDS III RBC Omics recalled donor population, we report a storage-dependent accumulation of free mono-, poly-(PUFAs), and highly unsaturated fatty acids (HUFAs), which occur at a faster rate than saturated fatty acid accumulation. Through a combination of immunofluorescence, pharmacological inhibition, tracing experiments with stable isotope-labeled fatty acids, and oxidant challenge with hydrogen peroxide, we demonstrate the presence and redox-sensitive activity of FADS2, FADS1, and FADS5 in the mature RBC. Increases in PUFAs and HUFAs in human and mouse RBCs correlate negatively with storage hemolysis and positively with posttransfusion recovery. Inhibition of these enzymes decreases accumulation of free PUFAs and HUFAs in stored RBCs, concomitant to increases in pyruvate/lactate ratios. Alterations of this ratio in G6PD deficient patients or units supplemented with pyruvate-rich rejuvenation solutions corresponded to decreased PUFA and HUFA accumulation. CONCLUSION Fatty acid desaturases are present and active in mature RBCs. Their activity is sensitive to oxidant stress, storage duration, and alterations of the pyruvate/lactate ratio.
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Affiliation(s)
| | - Francesca Cendali
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Xiaoyun Fu
- BloodWorks Northwest, Seattle, Washington, USA
| | - Fabia Gamboni
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Evan J Morrison
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jonathan Beirne
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Travis Nemkov
- Department of Biochemistry and Molecular Genetics, University of Colorado Denver-Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marianna H Antonelou
- Department of Biology, School of Science, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | | | - Ian Welsby
- Duke University, Durham, North Carolina, USA
| | - Ariel Hay
- Department of Pathology, University of Virginia, Charloteseville, Virginia, USA
| | | | | | | | | | | | - James C Zimring
- Department of Pathology, University of Virginia, Charloteseville, Virginia, USA
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13
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Williamson PC, Biggerstaff BJ, Simmons G, Stone M, Winkelman V, Latoni G, Alsina J, Bakkour S, Newman C, Pate LL, Galel SA, Kleinman S, Busch MP. Evolving viral and serological stages of Zika virus RNA-positive blood donors and estimation of incidence of infection during the 2016 Puerto Rican Zika epidemic: an observational cohort study. Lancet Infect Dis 2020; 20:1437-1445. [PMID: 32673594 DOI: 10.1016/s1473-3099(19)30706-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/31/2019] [Accepted: 11/14/2019] [Indexed: 01/11/2023]
Abstract
BACKGROUND Puerto Rico began screening blood donations for Zika virus RNA with nucleic acid amplification tests (NAATs) on April 3, 2016, because of an emerging Zika virus outbreak. We followed up positive donors to assess the dynamics of viral and serological markers during the early stages of Zika virus infection and update the estimate of infection incidence in the Puerto Rican population during the outbreak. METHODS Blood donations from volunteer donors in Puerto Rico were screened for the presence of Zika virus RNA using the cobas Zika NAAT. Positive donations were further tested to confirm infection, estimate viral load, and identify Zika virus-specific IgM antibodies. Individuals with positive blood donations were invited to attend follow-up visits. Donations with confirmed infection (defined as detection of Zika virus RNA or IgM on additional testing of index or follow-up samples) were assessed for stage of infection according to Zika virus RNA detectability in simulated minipools, viral load, and Zika virus IgM status. A three-step process was used to estimate the mean duration of NAAT reactivity of Zika virus in human plasma from individuals identified pre-seroconversion with at least one follow up visit and to update the 2016 incidence estimate of Zika virus infection. FINDINGS Between April 3 and Dec 31, 2016, 53 112 blood donations were screened for Zika virus, of which 351 tested positive, 339 had confirmed infections, and 319 could be staged. Compared with IgM-positive index donations (n=110), IgM-negative index donations (n=209) had higher mean viral loads (1·1 × 106vs 8·3 × 104 international units per mL) and were more likely to be detected in simulated minipools (93% [n=194] vs 26% [n=29]). The proportions of donations with confirmed infections that had viral RNA detected only in individual-donation NAATs (ie, not in simulated minipools) and were IgM positive increased as the epidemic evolved. The estimated mean duration of NAAT detectability in the 140 donors included in the follow-up study was 11·70 days (95% CI 10·06-14·36). Applying this detection period to the observed proportion of donations that were confirmed NAAT positive yielded a Zika virus seasonal incidence estimate of 21·1% (95% CI 18·1-24·1); 768 101 infections in a population of 3 638 773 in 2016. INTERPRETATION Characterisation of early Zika virus infection has implications for blood safety because infectivity of blood donations and utility of screening methods likely correlate with viral load and serological stage of infection. Our findings also have implications for diagnostic testing, public health surveillance, and epidemiology, and we estimate that around 21% of the Puerto Rican population was infected during the 2016 outbreak. FUNDING Biomedical Advanced Research and Development Authority, National Heart, Lung, and Blood Institute.
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Affiliation(s)
| | | | | | - Mars Stone
- Vitalant Research Institute, San Francisco, CA, USA
| | | | | | - Jose Alsina
- Banco de Sangre Servicios Mutuos, Guaynabo, PR, USA
| | | | - Christina Newman
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Lisa L Pate
- Roche Molecular Systems, Pleasanton, CA, USA
| | | | - Steven Kleinman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
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14
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Shteiner M, Kleinman S, Shuster A, Raiser V, Ianculovici C, Rachima H, Kaplan I. Submucosal Fibrotic Bands in Oral Lichen Planus: A Clinico-Pathological Investigation of a Newly Described Phenomenon. Head Neck Pathol 2020; 15:395-401. [PMID: 32705486 PMCID: PMC8134795 DOI: 10.1007/s12105-020-01203-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/04/2020] [Indexed: 12/19/2022]
Abstract
Fibrosis is a recognized complication of chronic inflammatory conditions, which has not yet been described in oral lichen planus. To describe characteristics of submucosal fibrotic bands in oral lichen planus. Prospective study. Patients with biopsy confirmed lichen planus were included. Clinical examination recorded fibrotic bands, mouth opening, vestibular depth loss, gingival recessions adjacent to band, lichen subtypes, areas of affected mucosa, extra-oral manifestations. Patients completed the Chronic Oral Mucosal Disease Questionnaire, with additional questions regarding stiffness, restricted opening, symptom frequency, time from diagnosis of lichen, co-existing medical conditions. 73 patients were included, 14 M, 59 F, age 28-84 (mean 61) years. Buccal fibrous bands were palpated in 22 (30.1%), 13 (59%) were bilateral. Self-reported restricted opening/stiffness were significantly associated with fibrous bands (36% Vs. 11% in controls, p = 0.02). Mouth opening less than 40 mm was recorded in only 2 (9%) with bands, none in controls. Reduced vestibular depth was significantly associated with bands (11 (50%) Vs 3 (6%) in controls, p = 0.0001).Gingival recessions adjacent to bands were recorded in 3 (13.6%). No association was demonstrated between fibrous bands and erosive lesions, extra oral involvement, smoking, age, visual analogue scale, quality of life questionaire and disease duration. Histological evaluation of one case each with and without band and control showed increased mean width of connective tissue. Submucous fibrous band is first described in the present study. It is common in oral lichen planus, may lead to feeling restricted mouth opening, stiffness, loss of vestibular depth and adjacent gingival recession.
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Affiliation(s)
- M. Shteiner
- Unit of Oral Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S. Kleinman
- Unit of Oral Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A. Shuster
- Unit of Oral Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel ,Goldschleger School of Dental Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - V. Raiser
- Unit of Oral Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - C. Ianculovici
- Unit of Oral Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - H. Rachima
- Unit of Oral Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - I. Kaplan
- Goldschleger School of Dental Medicine, Tel-Aviv University, Tel Aviv, Israel ,Institute of Pathology, Tel-Aviv Sourasky Medical Center, 5 Daphna St, Tel Aviv, Israel ,Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
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15
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Oz I, Kaplan I, Kleinman S, Arbel S, Shuster A. Medication-related osteonecrosis of the jaws associated with intravitreal administration of ranibizumab. Int J Oral Maxillofac Surg 2020; 49:1589-1591. [PMID: 32616306 DOI: 10.1016/j.ijom.2020.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/05/2020] [Accepted: 05/25/2020] [Indexed: 11/29/2022]
Abstract
Medication-related osteonecrosis of the jaws (MRONJ) is a well-known complication that, in the majority of cases, is related to antiresorptive agents. Numerous articles have described cases of MRONJ in bisphosphonate-naïve patients treated with anti-angiogenic agents administered via various routes. A single case of MRONJ after intravitreal injection of bevacizumab has been reported. We report a case of MRONJ after intravitreal injection of a different anti-angiogenic agent - ranibizumab - for the treatment of neovascular age-related macular degeneration, in a bisphosphonate-naïve patient. Although it may be a rare complication, patients treated with multiple doses of anti-angiogenic agents should be monitored for the possible early diagnosis of MRONJ.
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Affiliation(s)
- I Oz
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - I Kaplan
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - S Kleinman
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S Arbel
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - A Shuster
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Oral and Maxillofacial Surgery, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
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16
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DeSimone RA, Plimier C, Lee C, Kanias T, Cushing MM, Sachais BS, Kleinman S, Busch MP, Roubinian NH. Additive effects of blood donor smoking and gamma irradiation on outcome measures of red blood cell transfusion. Transfusion 2020; 60:1175-1182. [DOI: 10.1111/trf.15833] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/13/2020] [Accepted: 04/13/2020] [Indexed: 12/11/2022]
Affiliation(s)
| | - Colleen Plimier
- Kaiser Permanente Northern California Division of Research Oakland California USA
| | - Catherine Lee
- Kaiser Permanente Northern California Division of Research Oakland California USA
| | | | | | | | | | - Michael P. Busch
- Vitalant Research Institute San Francisco California USA
- University of California San Francisco California USA
| | - Nareg H. Roubinian
- Kaiser Permanente Northern California Division of Research Oakland California USA
- Vitalant Research Institute San Francisco California USA
- University of California San Francisco California USA
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17
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Gottschall J, Wu Y, Triulzi D, Kleinman S, Strauss R, Zimrin AB, McClure C, Tan S, Bialkowski W, Murphy E, Ness P. The epidemiology of platelet transfusions: an analysis of platelet use at 12 US hospitals. Transfusion 2019; 60:46-53. [PMID: 31850522 DOI: 10.1111/trf.15637] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 10/08/2019] [Accepted: 10/14/2019] [Indexed: 12/22/2022]
Abstract
BACKGROUND Using the Recipient and Donor Epidemiology Study-III (REDS-III) recipient and donor databases, we performed a retrospective analysis of platelet use in 12 US hospitals that were participants in REDS-III. STUDY DESIGN AND METHODS Data were electronically extracted from participating transfusion service and blood center computer systems and from medical records of the 12 REDS-III hospitals. All platelet transfusions from 2013 to 2016 given to patients aged 18 years and older were included in the analysis. RESULTS There were 28,843 inpatients and 2987 outpatients who were transfused with 163,719 platelet products (103,371 apheresis, 60,348 whole blood derived); 93.5% of platelets were leukoreduced and 72.5% were irradiated. Forty-six percent were transfused to patients with an International Classification of Diseases, 9th/10th Revision (ICD-9/10) diagnosis of leukemia, myelodysplastic syndrome (MDS), or lymphoma. The general ward and the intensive care unit (ICU) were the most common issue locations. Only 54% of platelet transfusions were ABO identical; and 60.6% of platelet transfusions given to Rh-negative patients were Rh positive. The most common pretransfusion platelet count range for inpatients was 20,000 to 50,000/μL, for outpatients it was 10,000 to 20,000/μL. Among ICU patients, 35% of platelet transfusion episodes had a platelet count of greater than 50,000/μL; this was only 8% for general ward and 2% for outpatients. The median posttransfusion increment, not corrected for platelet dose and/or patient size, ranged from 12,000 to 20,000/μL for inpatients, and from 17,000 to 27,000/μL for outpatients. CONCLUSIONS These data from one of the largest reviews of platelet transfusion practice to date provide guidance for where to focus future clinical research studies and platelet blood management programs.
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Affiliation(s)
| | - YanYun Wu
- Bloodworks Northwest, Seattle, Washington
| | | | - Steven Kleinman
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Ronald Strauss
- LifeSource/Institute for Transfusion Medicine, Chicago, Illinois
| | | | | | - Sylvia Tan
- RTI International, Raleigh, North Carolina
| | | | - Edward Murphy
- University of California San Francisco, San Francisco, California
| | - Paul Ness
- Johns Hopkins University, Baltimore, Maryland
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18
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Roubinian N, Kleinman S, Murphy EL, Glynn SA, Edgren G. Methodological considerations for linked blood donor-component-recipient analyses in transfusion medicine research. ACTA ACUST UNITED AC 2019; 15:185-193. [PMID: 32368251 DOI: 10.1111/voxs.12518] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
In recent years, there has been a concerted effort to improve our understanding of the quality and effectiveness of transfused blood components. The expanding use of large datasets built from electronic health records allows the investigation of potential benefits or adverse outcomes associated with transfusion therapy. Together with data collected on blood donors and components, these datasets permit an evaluation of associations between donor or blood component factors and transfusion recipient outcomes. Large linked donor-component recipient datasets provide the power to study exposures relevant to transfusion efficacy and safety, many of which would not otherwise be amenable to study for practical or sample size reasons. Analyses of these large blood banking-transfusion medicine datasets allow for characterization of the populations under study and provide an evidence base for future clinical studies. Knowledge generated from linked analyses have the potential to change the way donors are selected and how components are processed, stored and allocated. However, unrecognized confounding and biased statistical methods continue to be limitations in the study of transfusion exposures and patient outcomes. Results of observational studies of blood donor demographics, storage age, and transfusion practice have been conflicting. This review will summarize statistical and methodological challenges in the analysis of linked blood donor, component, and transfusion recipient outcomes.
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Affiliation(s)
- Nareg Roubinian
- Kaiser Permanente Northern California Division of Research, Oakland, California.,Vitalant Research Institute, San Francisco, California.,University of California, San Francisco, San Francisco, California
| | | | - Edward L Murphy
- University of California, San Francisco, San Francisco, California.,Vitalant Research Institute, San Francisco, California
| | - Simone A Glynn
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Gustaf Edgren
- Department of Medicine Solna, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden.,Department of Cardiology, Södersjukhuset, Stockholm, Sweden
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19
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Spencer BR, Guo Y, Cable RG, Kiss JE, Busch MP, Page GP, Endres-Dighe SM, Kleinman S, Glynn SA, Mast AE. Iron status and risk factors for iron depletion in a racially/ethnically diverse blood donor population. Transfusion 2019; 59:3146-3156. [PMID: 31318071 DOI: 10.1111/trf.15448] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND The optimal approach for reducing iron depletion (ID) in blood donors may vary depending on biologic or behavioral differences across donors. STUDY DESIGN AND METHODS More than 12,600 successful whole blood donors were enrolled from four US blood centers for ferritin testing. The study population was enriched for racial/ethnic minorities (1605 African American, 1616 Asian, 1023 Hispanic). Subjects completed questionnaires on ID risk factors. Logistic regression identified predictors of absent iron stores (AIS; ferritin <12 ng/mL) and low ferritin (LF; ferritin <26 ng/mL). RESULTS Across all subjects, 19% had AIS and 42% had LF, with a sharp increase in risk observed with increasing donation intensity and among women a large decrease in risk in those more than 50 years old. When other factors were controlled for, African American and Asian donors showed 20% to 25% decreased risk for AIS compared to non-Hispanic Caucasian donors, while Hispanic donors had 25% higher risk. Daily iron supplementation reduced risk for LF and AIS by 30% to 40%, respectively, while the benefit from less frequent use was lower (7%-19% protection). Regular antacid use was associated with at least 20% increment to risk. Use of oral contraceptives or estrogen in females reduced risk by 16% to 22%, while males who reported supplemental testosterone use had a 50% to 125% greater risk for LF and AIS. CONCLUSIONS This study confirms high prevalence of LF and AIS in US donors and the principal risk factors of age, sex, and donation frequency. Additional demographic and behavioral risk factors of secondary importance might allow for refinement of ID mitigation strategies.
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Affiliation(s)
- Bryan R Spencer
- American Red Cross Scientific Affairs, Dedham, Massachusetts
| | | | | | - Joseph E Kiss
- Vitalant Northeast Division (formerly The Institute for Transfusion Medicine), Pittsburgh, Pennsylvania
| | | | | | | | - Steven Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
| | - Simone A Glynn
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Alan E Mast
- Blood Research Institute, Versiti (formerly, Blood Center of Wisconsin), Milwaukee, Wisconsin.,Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, Wisconsin
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20
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Cushing MM, Pagano MB, Jacobson J, Schwartz J, Grossman BJ, Kleinman S, Han MA, Cohn CS. Pathogen reduced plasma products: a clinical practice scientific review from the AABB. Transfusion 2019; 59:2974-2988. [DOI: 10.1111/trf.15435] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/01/2019] [Accepted: 06/03/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Melissa M. Cushing
- Department of Pathology and Laboratory MedicineWeill Cornell Medicine New York New York
| | - Monica B. Pagano
- Department of Laboratory MedicineUniversity of Washington Medical Center Seattle Washington
| | | | - Joseph Schwartz
- Department of Pathology & Cell BiologyColumbia University Vagelos College of Physicians and Surgeons New York New York
| | - Brenda J. Grossman
- Department of Pathology & ImmunologyWashington University School of Medicine in St. Louis St. Louis Missouri
| | - Steven Kleinman
- Department of Pathology & Laboratory MedicineThe University of British Columbia Vancouver British Columbia
| | - Mi Ah Han
- Department of Preventive MedicineCollege of Medicine Chosun University Gwangju Republic of Korea
| | - Claudia S. Cohn
- Department of Laboratory Medicine and PathologyUniversity of Minnesota Minneapolis Minnesota
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21
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Roubinian N, Kleinman S. Building consensus: steps toward standardised haemovigilance reporting. The Lancet Haematology 2019; 6:e339-e340. [DOI: 10.1016/s2352-3026(19)30081-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 04/23/2019] [Indexed: 12/14/2022]
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22
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Spencer BR, Bialkowski W, Creel DV, Cable RG, Kiss JE, Stone M, McClure C, Kleinman S, Glynn SA, Mast AE. Elevated risk for iron depletion in high-school age blood donors. Transfusion 2019; 59:1706-1716. [PMID: 30633813 PMCID: PMC6499707 DOI: 10.1111/trf.15133] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/08/2018] [Accepted: 11/08/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND High school students 16 to 18 years-old contribute 10% of the US blood supply. Mitigating iron depletion in these donors is important because they continue to undergo physical and neurocognitive development. STUDY DESIGN AND METHODS Study objectives were to determine the prevalence of iron depletion in 16- to 18-year-old donors and whether their risk for iron depletion was greater than adult donors. Successful, age-eligible donors were enrolled from high school blood drives at two large US blood centers. Plasma ferritin testing was performed with ferritin less than 12 ng/mL as our primary measure of iron depletion and ferritin less than 26 ng/mL a secondary measure. Multivariable repeated-measures logistic regression models evaluated the role of age and other demographic/donation factors. RESULTS Ferritin was measured from 4265 enrollment donations September to November 2015 and 1954 follow-up donations through May 2016. At enrollment, prevalence of ferritin less than 12 ng/mL in teenagers was 1% in males and 18% in females making their first blood donation, and 8% in males and 33% in females with prior donations. Adjusted odds for ferritin less than 12 ng/mL were 2.1 to 2.8 times greater in 16- to 18-year-olds than in 19- to 49-year-olds, and for ferritin less than 26 ng/mL were 3.3- to 4.7-fold higher in 16- to 18-year-olds. Progression to hemoglobin deferral was twice as likely in 16- to 18-year-old versus 19- to 49-year-old females. CONCLUSION Age 16 to 18 years-old is an independent risk factor for iron deficiency in blood donors at any donation frequency. Blood centers should implement alternate eligibility criteria or additional safety measures to protect teenage donors from iron depletion.
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Affiliation(s)
- Bryan R. Spencer
- American Red Cross, Scientific Affairs, Dedham, MA, United States
| | - Walter Bialkowski
- Blood Research Institute, BloodCenter of Wisconsin Milwaukee, WI, United States
| | | | - Ritchard G. Cable
- American Red Cross, Scientific Affairs, Farmington, CT, United States
| | - Joseph E. Kiss
- Institute for Transfusion Medicine, Pittsburgh, PA, United States
| | - Mars Stone
- Blood Systems Research Institute, San Francisco, CA, United States
| | | | | | - Simone A. Glynn
- National Heart, Lung, and Blood Institute, Bethesda, MD, United States
| | - Alan E. Mast
- Blood Research Institute, BloodCenter of Wisconsin Milwaukee, WI, United States
- Department of Cell Biology, Neurobiology and Anatomy, Medical College of Wisconsin, Milwaukee, WI, United States
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23
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St Lezin E, Karafin MS, Bruhn R, Chowdhury D, Qu L, Bialkowski W, Merenda S, D'Andrea P, McCalla AL, Anderson L, Keating SM, Stone M, Snyder EL, Brambilla D, Murphy EL, Norris PJ, Hilton JF, Spencer BR, Kleinman S, Carson JL. Therapeutic impact of red blood cell transfusion on anemic outpatients: the RETRO study. Transfusion 2019; 59:1934-1943. [PMID: 30882919 DOI: 10.1111/trf.15249] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Patients with cancer or other diagnoses associated with chronic anemia often receive red blood cell (RBC) transfusion as outpatients, but the effect of transfusion on functional status is not well demonstrated. STUDY DESIGN AND METHODS To estimate the effect of transfusion on functional status and quality of life, we measured 6-minute walk test distance and fatigue- and dyspnea-related quality-of-life scores before and 1 week after RBC transfusion in 208 outpatients age ≥50 with at least one benign or malignant hematology/oncology diagnosis. To account for potential confounding effects of cancer treatment, patients were classified into two groups based on cancer treatment within 4 weeks of the study transfusion. Minimum clinically important improvements over baseline were 20 meters in walk test distance, 3 points in fatigue score, and 2 points in dyspnea score. RESULTS The median improvement in unadjusted walk test distance was 20 meters overall and 30 meters in patients not receiving recent cancer treatment. Fatigue scores improved overall by a median of 3 points and by 4 points in patients without cancer treatment. There was no clinically important change in dyspnea scores. In multiple linear regression analysis, patients who maintained hemoglobin (Hb) levels of 8 g/dL or greater at 1 week posttransfusion, who had not received recent cancer treatment, and who did not require hospitalization during the study showed clinically important increases in mean walk test distance. CONCLUSIONS Red blood cell transfusion is associated with a modest, but clinically important improvement in walk test distance and fatigue score outcomes in adult hematology/oncology outpatients.
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Affiliation(s)
- Elizabeth St Lezin
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California.,Department of Laboratory Medicine, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Matthew S Karafin
- Medical Sciences Institute (MSI), BloodCenter of Wisconsin, Milwaukee, Wisconsin
| | - Roberta Bruhn
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California.,Vitalant Research Institute, San Francisco, California
| | | | - Lirong Qu
- University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Walter Bialkowski
- Medical Sciences Institute (MSI), BloodCenter of Wisconsin, Milwaukee, Wisconsin
| | | | | | | | - Lisa Anderson
- Medical Sciences Institute (MSI), BloodCenter of Wisconsin, Milwaukee, Wisconsin
| | | | - Mars Stone
- Vitalant Research Institute, San Francisco, California
| | | | | | - Edward L Murphy
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California.,Vitalant Research Institute, San Francisco, California
| | - Philip J Norris
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California.,Vitalant Research Institute, San Francisco, California
| | - Joan F Hilton
- Department of Laboratory Medicine, University of California San Francisco, San Francisco, California
| | | | - Steven Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
| | - Jeffrey L Carson
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
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24
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Roubinian NH, Murphy EL, Mark DG, Triulzi DJ, Carson JL, Lee C, Kipnis P, Kleinman S, Liu VX, Escobar GJ. Long-Term Outcomes Among Patients Discharged From the Hospital With Moderate Anemia: A Retrospective Cohort Study. Ann Intern Med 2019; 170:81-89. [PMID: 30557414 PMCID: PMC6639156 DOI: 10.7326/m17-3253] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Randomized clinical trial findings support decreased red blood cell (RBC) transfusion and short-term tolerance of in-hospital anemia. However, long-term outcomes related to changes in transfusion practice have not been described. OBJECTIVE To describe the prevalence of anemia at and after hospital discharge and associated morbidity and mortality events. DESIGN Retrospective cohort study. SETTING Integrated health care delivery system with 21 hospitals serving 4 million members. PARTICIPANTS 445 371 surviving adults who had 801 261 hospitalizations between January 2010 and December 2014. MEASUREMENTS Hemoglobin levels and RBC transfusion, rehospitalization, and mortality events within 6 months of hospital discharge. Generalized estimating equations were used to examine trends over time, accounting for correlated observations and patient-level covariates. RESULTS From 2010 to 2014, the prevalence of moderate anemia (hemoglobin levels between 7 and 10 g/dL) at hospital discharge increased from 20% to 25% (P < 0.001) and RBC transfusion declined by 28% (39.8 to 28.5 RBC units per 1000 patients; P < 0.001). The proportion of patients whose moderate anemia had resolved within 6 months of hospital discharge decreased from 42% to 34% (P < 0.001), and RBC transfusion and rehospitalization within 6 months of hospital discharge decreased from 19% to 17% and 37% to 33%, respectively (P < 0.001 for both). During this period, the adjusted 6-month mortality rate decreased from 16.1% to 15.6% (P = 0.004) in patients with moderate anemia, in parallel with that of all others. LIMITATION Possible unmeasured confounding. CONCLUSION Anemia after hospitalization increased in parallel with decreased RBC transfusion. This increase was not accompanied by a rise in subsequent RBC use, rehospitalization, or mortality within 6 months of hospital discharge. Longitudinal analyses support the safety of practice recommendations to limit RBC transfusion and tolerate anemia during and after hospitalization. PRIMARY FUNDING SOURCE National Heart, Lung, and Blood Institute.
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Affiliation(s)
- Nareg H Roubinian
- Kaiser Permanente Northern California, Oakland, and Blood Systems Research Institute and University of California, San Francisco, San Francisco, California (N.H.R.)
| | - Edward L Murphy
- Blood Systems Research Institute and University of California, San Francisco, San Francisco, California (E.L.M.)
| | - Dustin G Mark
- Kaiser Permanente Northern California, Oakland, California (D.G.M., C.L., P.K., V.X.L., G.J.E.)
| | - Darrell J Triulzi
- Institute for Transfusion Medicine, Pittsburgh, Pennsylvania (D.J.T.)
| | - Jeffrey L Carson
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey (J.L.C.)
| | - Catherine Lee
- Kaiser Permanente Northern California, Oakland, California (D.G.M., C.L., P.K., V.X.L., G.J.E.)
| | - Patricia Kipnis
- Kaiser Permanente Northern California, Oakland, California (D.G.M., C.L., P.K., V.X.L., G.J.E.)
| | - Steven Kleinman
- University of British Columbia, Victoria, British Columbia, Canada (S.K.)
| | - Vincent X Liu
- Kaiser Permanente Northern California, Oakland, California (D.G.M., C.L., P.K., V.X.L., G.J.E.)
| | - Gabriel J Escobar
- Kaiser Permanente Northern California, Oakland, California (D.G.M., C.L., P.K., V.X.L., G.J.E.)
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25
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Lanteri MC, Kanias T, Keating S, Stone M, Guo Y, Page GP, Brambilla DJ, Endres-Dighe SM, Mast AE, Bialkowski W, D'Andrea P, Cable RG, Spencer BR, Triulzi DJ, Murphy EL, Kleinman S, Gladwin MT, Busch MP. Intradonor reproducibility and changes in hemolytic variables during red blood cell storage: results of recall phase of the REDS-III RBC-Omics study. Transfusion 2018; 59:79-88. [PMID: 30408207 DOI: 10.1111/trf.14987] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 09/11/2018] [Accepted: 09/12/2018] [Indexed: 12/18/2022]
Abstract
BACKGROUND Genetic determinants may underlie the susceptibility of red blood cells (RBCs) to hemolyze in vivo and during routine storage. This study characterized the reproducibility and dynamics of in vitro hemolysis variables from a subset of the 13,403 blood donors enrolled in the RBC-Omics study. STUDY DESIGN AND METHODS RBC-Omics donors with either low or high hemolysis results on 4°C-stored leukoreduced (LR)-RBC samples from enrollment donations stored for 39 to 42 days were recalled 2 to 12 months later to donate LR-RBCs. Samples of stored LR-RBCs from the unit and from transfer bags were evaluated for spontaneous and stress-induced hemolysis at selected storage time points. Intradonor reproducibility of hemolysis variables was evaluated in transfer bags over two donations. Hemolysis data at serial storage time points were generated on LR-RBCs from parent bags and analyzed by site, sex, race/ethnicity, and donation frequency. RESULTS A total of 664 donors were successfully recalled. Analysis of intradonor reproducibility revealed that osmotic and oxidative hemolysis demonstrated good and moderate reproducibility (Pearson's r = 0.85 and r = 0.53, respectively), while spontaneous hemolysis reproducibility was poor (r = 0.40). Longitudinal hemolysis in parent bags showed large increases over time in spontaneous (508.6%) and oxidative hemolysis (399.8%) and smaller increases in osmotic (9.4%) and mechanical fragility (3.4%; all p < 0.0001). CONCLUSION Spontaneous hemolysis is poorly reproducible in donors over time and may depend on site processing methods, while oxidative and osmotic hemolysis were reproducible in donors and hence could reflect consistent heritable phenotypes attributable to genetic traits. Spontaneous and oxidative hemolysis increased over time of storage, whereas osmotic and mechanical hemolysis remained relatively stable.
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Affiliation(s)
- Marion C Lanteri
- Vitalant Research Institute (previously Blood Systems Research Institute), University of San Francisco, San Francisco, California.,Department of Laboratory Medicine, University of San Francisco, San Francisco, California
| | - Tamir Kanias
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, Atlanta, Georgia.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Atlanta, Georgia
| | - Sheila Keating
- Vitalant Research Institute (previously Blood Systems Research Institute), University of San Francisco, San Francisco, California.,Department of Laboratory Medicine, University of San Francisco, San Francisco, California
| | - Mars Stone
- Vitalant Research Institute (previously Blood Systems Research Institute), University of San Francisco, San Francisco, California.,Department of Laboratory Medicine, University of San Francisco, San Francisco, California
| | | | | | | | | | - Alan E Mast
- Blood Research and Medical Sciences Institutes, Blood Center of Wisconsin, Milwaukee, Wisconsin
| | - Walter Bialkowski
- Blood Research and Medical Sciences Institutes, Blood Center of Wisconsin, Milwaukee, Wisconsin
| | - Pam D'Andrea
- The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
| | | | | | - Darrell J Triulzi
- The Institute for Transfusion Medicine, Pittsburgh, Pennsylvania.,Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Edward L Murphy
- Vitalant Research Institute (previously Blood Systems Research Institute), University of San Francisco, San Francisco, California.,Department of Laboratory Medicine, University of San Francisco, San Francisco, California
| | - Steven Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
| | - Mark T Gladwin
- Pittsburgh Heart, Lung, Blood and Vascular Medicine Institute, Atlanta, Georgia.,Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Atlanta, Georgia
| | - Michael P Busch
- Vitalant Research Institute (previously Blood Systems Research Institute), University of San Francisco, San Francisco, California.,Department of Laboratory Medicine, University of San Francisco, San Francisco, California
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26
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Kleinman S, Stassinopoulos A. Transfusion-associated graft-versus-host disease reexamined: potential for improved prevention using a universally applied intervention. Transfusion 2018; 58:2545-2563. [DOI: 10.1111/trf.14930] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/27/2018] [Accepted: 07/29/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Steven Kleinman
- Clinical Pathology; University of British Columbia, School of Medicine; Vancouver British Columbia Canada
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27
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Shuster A, Reiser V, Trejo L, Ianculovici C, Kleinman S, Kaplan I. Comparison of the histopathological characteristics of osteomyelitis, medication-related osteonecrosis of the jaw, and osteoradionecrosis. Int J Oral Maxillofac Surg 2018; 48:17-22. [PMID: 30054185 DOI: 10.1016/j.ijom.2018.07.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/25/2018] [Accepted: 07/03/2018] [Indexed: 10/28/2022]
Abstract
The purpose of this study was to compare the histopathological parameters of chronic/suppurative osteomyelitis, medication-related osteonecrosis of the jaw (MRONJ), and osteoradionecrosis (ORN), and to examine the hypothesis that distinct histological features can be related to a specific disease, allowing for diagnosis based on microscopic evaluation alone. One hundred and ten samples were reviewed by two examiners in a blinded fashion, and a semi-quantitative histomorphometric analysis was performed. The parameters evaluated included the presence or absence of necrotic bone, inflammation, reactive bone formation, bacteria, and osteoclasts. No statistically significant differences were found between groups for any parameter. Necrotic bone was common to all three diagnoses. Inflammation and reactive bone formation were present in all three diagnoses. The presence of bacteria was a prominent feature in all cases. Osteoclasts were scarce in MRONJ and osteomyelitis, and non-existent in ORN. The results of this study failed to identify distinctive microscopic characteristics in any of the three entities that could be used to differentiate between them. Therefore, it is impossible to reach a specific final diagnosis based on microscopic findings alone. The role of microscopic analysis is to serve as an aid to diagnosis that must be complemented by the patient's history and imaging.
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Affiliation(s)
- A Shuster
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Oral and Maxillofacial Surgery, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - V Reiser
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Department of Oral and Maxillofacial Surgery, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Trejo
- Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - C Ianculovici
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - S Kleinman
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - I Kaplan
- Department of Otolaryngology, Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Institute of Pathology, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Oral Pathology and Oral Medicine, Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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28
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Yazer MH, Seheult J, Kleinman S, Sloan SR, Spinella PC. Who's afraid of incompatible plasma? A balanced approach to the safe transfusion of blood products containing ABO-incompatible plasma. Transfusion 2017; 58:532-538. [PMID: 29193106 DOI: 10.1111/trf.14415] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/16/2017] [Accepted: 10/16/2017] [Indexed: 01/12/2023]
Affiliation(s)
- Mark H Yazer
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jansen Seheult
- Department of Pathology, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Steven Kleinman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Victoria, British Columbia, Canada
| | - Steven R Sloan
- Department of Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Philip C Spinella
- Department of Pediatrics, Division of Critical Care Medicine, Washington University in St Louis, St Louis, Missouri
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29
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Pesis M, Koren I, Safadi A, Reiser V, Benjamin S, Shuster A, Kleinman S. Retrospective evaluation of bone graft and dental implants survival after combined one step double-team endoscopic sinus surgery and sinus floor elevation procedure. Int J Oral Maxillofac Surg 2017. [DOI: 10.1016/j.ijom.2017.02.917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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30
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Kaplan I, Kleinman S, Frenkel G, Fliss D, Shlomi B. A RARE VARIANT OF SQUAMOUS ODONTOGENIC TUMOR WITH CORTICAL PERFORATION AND HIGH PROLIFERATION INDEX. Oral Surg Oral Med Oral Pathol Oral Radiol 2016. [DOI: 10.1016/j.oooo.2016.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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31
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Lelie N, Bruhn R, Busch M, Vermeulen M, Tsoi W, Kleinman S, Coleman C, Reddy R, Bird A, Cable R, Goubran H, Moftah F, Ekiaby ME, Ghiazza P, Manzini P, Favilli F, Peduzzi C, Roig R, Alvarez M, Sauleda S, Niederhauser C, Levicnik S, Nograsek P, Wessberg S, Elkblom S, Lankinen M, Ulm H, Harritshoj L, Nielsen C, Jorgensen S, Erikstrup C, O'Riordan J, Brojer E, Grabarczyk P, Gdowska J, Pitotrowski D, Lam S, Teo D, Chua SS, Lin CK, Bon AH, Peng SLT, Flanagan P, Brown S, Kiely P, Seed C, Castro E, Gonzales R. Detection of different categories of hepatitis B virus (HBV) infection in a multi‐regional study comparing the clinical sensitivity of hepatitis B surface antigen and HBV‐DNA testing. Transfusion 2016; 57:24-35. [DOI: 10.1111/trf.13819] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Revised: 08/01/2016] [Accepted: 08/01/2016] [Indexed: 01/19/2023]
Affiliation(s)
| | - Roberta Bruhn
- Blood Systems Research InstituteSan Francisco California
| | - Michael Busch
- Blood Systems Research InstituteSan Francisco California
| | | | - Wai‐Chiu Tsoi
- Hong Kong Red Cross Blood Transfusion ServiceHong Kong China
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32
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Whitaker B, Rajbhandary S, Kleinman S, Harris A, Kamani N. Trends in United States blood collection and transfusion: results from the 2013 AABB Blood Collection, Utilization, and Patient Blood Management Survey. Transfusion 2016; 56:2173-83. [DOI: 10.1111/trf.13676] [Citation(s) in RCA: 130] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 04/25/2016] [Accepted: 04/25/2016] [Indexed: 11/30/2022]
Affiliation(s)
| | | | | | | | - Naynesh Kamani
- Center for Cellular Therapies & ResearchAABBBethesda Maryland
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33
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Spencer BR, Johnson B, Wright DJ, Kleinman S, Glynn SA, Cable RG. Potential impact on blood availability and donor iron status of changes to donor hemoglobin cutoff and interdonation intervals. Transfusion 2016; 56:1994-2004. [PMID: 27237451 DOI: 10.1111/trf.13663] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2016] [Revised: 04/07/2016] [Accepted: 04/09/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND A minimum male hemoglobin (Hb) level of 13.0 g/dL becomes a Food and Drug Administration requirement effective May 2016. In addition, extending whole blood (WB) interdonation intervals (IDIs) beyond 8 weeks has been considered to reduce iron depletion in repeat blood donors. This study estimates the impact these changes might have on blood availability and donor iron status. STUDY DESIGN AND METHODS Six blood centers participating in Retrovirus Epidemiology Donor Study-II (REDS-II) collected information on all donation visits from 2006 to 2009. Simulations were developed from these data using a multistage approach that first sought to adequately reproduce the patterns of donor return, Hb and ferritin levels, and outcomes of a donor's visit (successful single- or double-red blood cell donation, deferral for low Hb) observed in REDS-II data sets. Modified simulations were used to predict the potential impact on the blood supply and donor iron status under different Hb cutoff and IDI qualification criteria. RESULTS More than 10% of WB donations might require replacement under many simulated scenarios. Longer IDIs would reduce the proportion of donors with iron depletion, but 80% of these donors may remain iron-depleted if minimal IDIs increased to 12 or 16 weeks. CONCLUSION Higher Hb cutoffs and longer IDIs are predicted to have a potentially large impact on collections but only a modest impact on donor iron depletion. Efforts to address iron depletion should be targeted to at-risk donors, such as iron supplementation programs for frequent donors, and policy makers should try to avoid broadly restrictive donation requirements that could substantially reduce blood availability.
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Affiliation(s)
- Bryan R Spencer
- American Red Cross Blood Services, Massachusetts Region, Dedham, Massachusetts
| | | | | | | | - Simone A Glynn
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Ritchard G Cable
- American Red Cross Blood Services, Connecticut Region, Farmington, Connecticut
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34
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Cable RG, Brambilla D, Glynn SA, Kleinman S, Mast AE, Spencer BR, Stone M, Kiss JE. Effect of iron supplementation on iron stores and total body iron after whole blood donation. Transfusion 2016; 56:2005-12. [PMID: 27232535 DOI: 10.1111/trf.13659] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/12/2016] [Accepted: 04/16/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Understanding the effect of blood donation and iron supplementation on iron balance will inform strategies to manage donor iron status. STUDY DESIGN AND METHODS A total of 215 donors were randomized to receive ferrous gluconate daily (37.5 mg iron) or no iron for 24 weeks after blood donation. Iron stores were assessed using ferritin and soluble transferrin receptor. Hemoglobin (Hb) iron was calculated from total body Hb. Total body iron (TBI) was estimated by summing iron stores and Hb iron. RESULTS At 24 weeks, TBI in donors taking iron increased by 281.0 mg (95% confidence interval [CI], 223.4-338.6 mg) compared to before donation, while TBI in donors not on iron decreased by 74.1 mg (95% CI, -112.3 to -35.9; p < 0.0001, iron vs. no iron). TBI increased rapidly after blood donation with iron supplementation, especially in iron-depleted donors. Supplementation increased TBI compared to controls during the first 8 weeks after donation: 367.8 mg (95% CI, 293.5-442.1) versus -24.1 mg (95% CI, -82.5 to 34.3) for donors with a baseline ferritin level of not more than 26 ng/mL and 167.8 mg (95% CI, 116.5-219.2) versus -68.1 mg (95% CI, -136.7 to 0.5) for donors with a baseline ferritin level of more than 26 ng/mL. A total of 88% of the benefit of iron supplementation occurred during the first 8 weeks after blood donation. CONCLUSION Donors on iron supplementation replaced donated iron while donors not on iron did not. Eight weeks of iron supplementation provided nearly all of the measured improvement in TBI. Daily iron supplementation after blood donation allows blood donors to recover the iron loss from blood donation and prevents sustained iron deficiency.
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Affiliation(s)
| | | | - Simone A Glynn
- National Heart, Lung, and Blood Institute, Bethesda, Maryland
| | - Steven Kleinman
- University of British Columbia, Victoria, British Columbia, Canada
| | - Alan E Mast
- BloodCenter of Wisconsin, Milwaukee, Wisconsin
| | | | - Mars Stone
- Blood Systems Research Institute, San Francisco, California
| | - Joseph E Kiss
- Institute for Transfusion Medicine, Pittsburgh, Pennsylvania
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35
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Busch MP, Sabino EC, Brambilla D, Lopes ME, Capuani L, Chowdhury D, McClure C, Linnen JM, Prince H, Simmons G, Lee TH, Kleinman S, Custer B. Duration of Dengue Viremia in Blood Donors and Relationships Between Donor Viremia, Infection Incidence and Clinical Case Reports During a Large Epidemic. J Infect Dis 2016; 214:49-54. [PMID: 27302934 DOI: 10.1093/infdis/jiw122] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2015] [Accepted: 03/22/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Dengue viruses (DENV-1-4) pose a transfusion-transmission risk. This study estimated the dengue RNA detection period in asymptomatic blood donors and relationships between donor viremia and dengue incidence during a large epidemic. METHODS Donor samples from the 2012 dengue transmission season in Rio de Janeiro, Brazil, were tested for DENV RNA by a transcription-mediated amplification (TMA) assay, with DENV types and viral loads determined by polymerase chain reaction. Samples collected during the first and last weeks of enrollment were tested for DENV immunoglobulin (Ig) G and IgM to estimate incidence during the study period, which was analyzed relative to nucleic acid amplification technology (NAT) yield to estimate the duration of NAT-detectable viremia and compared with reported clinical dengue cases in Rio. RESULTS Samples from 16 241 donations were tested; 87 (0.54%) were confirmed as DENV-4 RNA positive. Dengue IgM-positive/IgG-positive reactivity increased from 2.8% to 8.8%, indicating a 6.2% incidence (95% confidence interval [CI], 3.2%-9.1%) during the study period. Based on these data, we estimated a 9.1-day period (95% CI, 4.4-13.9 days) of RNA detectable with TMA. With 100 475 reported cases of clinical dengue, 1 RNA-positive donation was identified per 800 DENV cases. CONCLUSIONS These parameters allow projections of dengue incidence from donor NAT yield data and vice versa, and suggest that viremic donations will be rare relative to clinical disease cases.
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Affiliation(s)
- Michael P Busch
- Blood Systems Research Institute Department of Laboratory Medicine, University of California, San Francisco
| | - Ester C Sabino
- Department of Infectious Diseases and Institute of Tropical Medicine, University of Sao Paulo
| | | | | | - Ligia Capuani
- Department of Infectious Diseases and Institute of Tropical Medicine, University of Sao Paulo
| | | | | | | | - Harry Prince
- Focus Diagnostics, San Juan Capistrano, California
| | - Graham Simmons
- Blood Systems Research Institute Department of Laboratory Medicine, University of California, San Francisco
| | | | | | - Brian Custer
- Blood Systems Research Institute Department of Laboratory Medicine, University of California, San Francisco
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Heddle NM, Boeckh M, Grossman B, Jacobson J, Kleinman S, Tobian AA, Webert K, Wong EC, Roback JD. AABB Committee Report: reducing transfusion-transmitted cytomegalovirus infections. Transfusion 2016; 56:1581-7. [DOI: 10.1111/trf.13503] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 11/30/2015] [Accepted: 11/30/2015] [Indexed: 12/16/2022]
Affiliation(s)
| | - Nancy M. Heddle
- Department of Medicine; McMaster Centre for Transfusion Research
- Canadian Blood Services & Division of Clinical Pathology; McMaster University; Hamilton Ontario Canada
| | - Michael Boeckh
- Vaccine and Infectious Disease Division; Fred Hutchinson Cancer Research Center, and the University of Washington; Seattle Washington
| | - Brenda Grossman
- Division of Laboratory and Genomic Medicine; Department of Pathology and Immunology, Washington University in St Louis; St Louis Missouri
| | - Jessica Jacobson
- Department of Pathology; Bellevue Hospital Center, New York University School of Medicine; New York New York
| | - Steven Kleinman
- University of British Columbia, Victoria, Canada, and Medical Advisor to AABB; Bethesda Maryland
| | - Aaron A.R. Tobian
- Division of Transfusion Medicine; Department of Pathology; Johns Hopkins University; Baltimore Maryland
| | - Kathryn Webert
- Canadian Blood Services & Division of Clinical Pathology; McMaster University; Hamilton Ontario Canada
| | - Edward C.C. Wong
- Division of Laboratory Medicine; Departments of Pediatrics and Pathology; Children's National Medical Center, George Washington School of Medicine and Health Sciences; Washington DC
| | - John D. Roback
- Department of Pathology and Laboratory Medicine; Center for Transfusion and Cellular Therapies, Emory University School of Medicine; Atlanta Georgia
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Kleinman S, Glynn SA. Database research in transfusion medicine: The power of large numbers. Transfusion 2015; 55:1591-5. [DOI: 10.1111/trf.13139] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 03/25/2015] [Indexed: 01/03/2023]
Affiliation(s)
| | - Simone A. Glynn
- Blood Epidemiology and Clinical Therapeutics Branch, Division of Blood Diseases and Resources; National Heart, Lung, and Blood Institute, National Institutes of Health; Bethesda MD
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Horowitz G, Koren I, Carmel NN, Balaban S, Abu-Ghanem S, Fliss DM, Kleinman S, Reiser V. [One stage combined endoscopic and per-oral buccal fat pad approach for large oro-antral-fistula closure with secondary chronic maxillary sinusitis]. Refuat Hapeh Vehashinayim (1993) 2015; 32:32-68. [PMID: 26548148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
There are numerous surgical approaches for oro-antral-fistula (OAF) closure. Secondary sinus disease is still considered by many experts a relative contra indication for primary closure. To describe a single-stage combined endoscopic sinus surgery and per-oral buccal fat pad (BFP) flap approach for large OAF causing chronic maxillary sinusitis. The records of all the patients with OAF and chronic manifestations of secondary rhinosinusitis that were treated between 2010 and 2013 in our tertiary care medical center were reviewed. The exclusion criteria were: OAF 5 mm, resolved sino-nasal disease, OAF secondary to malignancy, recurrent fistula, medical history that included radiotherapy to the maxillary bone and age <18 years. Each procedure was performed by a team consisting of a rhinologist and a maxillofacial surgeon. The surgical approach included an endoscopic middle antrostomy with maxillary sinus drainage, and a per-oral BFP regional flap for OAF closure. Total OAF closure, complications and need for revision surgeries. Forty-five patients that underwent OAF closure together with sinus surgery using a combined endoscopic sinus surgery (ESS) and BFP flap approach met the inclusion criteria. There were 28 males and 17 females with a mean ± SD age of 53.5 ± 14.9 years (range 22-80 years). The presenting signs and symptoms included purulent rhinorrhea (n = 22, 48.9%), foreign body in sinus (n = 10, 22.2%) nasal congestion (n = 7, 15.5%), halitosis (n = 6, 13.3%) and pain (n = 5, 12.2%). Surgical complications included local pain (n = 2, 4.4%), persistent rhinitis (n = 2, 4.4%) and synechia (n = 1, 2.2%). One patient required revision surgery due, to an unresolved OAF. The OAF of all the other 44 patients (97.8%) was closed after the first procedure and the paranasal sinuses on the treated side were completely recovered. The mean follow-up time for the group was 7.6 ± 4.3 months (7-21 months), and no untoward sequelae or recurrence were reported. Combined, one step, endoscopic Maxillary sinus drainage together with per-oral BFP flap approach is an efficacious surgical approach for safe closure of OAFs that are complicated with secondary chronic maxillary sinusitis.
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Bruhn R, Lelie N, Busch M, Kleinman S. Relative efficacy of nucleic acid amplification testing and serologic screening in preventing hepatitis C virus transmission risk in seven international regions. Transfusion 2015; 55:1195-205. [DOI: 10.1111/trf.13024] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 12/19/2014] [Accepted: 12/20/2014] [Indexed: 12/21/2022]
Affiliation(s)
- Roberta Bruhn
- Blood Systems Research Institute; San Francisco California
| | | | - Michael Busch
- Blood Systems Research Institute; San Francisco California
| | - Steven Kleinman
- University of British Columbia; Victoria British Columbia Canada
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Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, Tinmouth AT, Capocelli KE, Cipolle MD, Cohn CS, Fung MK, Grossman BJ, Mintz PD, O'Malley BA, Sesok-Pizzini DA, Shander A, Stack GE, Webert KE, Weinstein R, Welch BG, Whitman GJ, Wong EC, Tobian AA. Platelet transfusion: a clinical practice guideline from the AABB. Ann Intern Med 2015; 162:205-13. [PMID: 25383671 DOI: 10.7326/m14-1589] [Citation(s) in RCA: 563] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The AABB (formerly, the American Association of Blood Banks) developed this guideline on appropriate use of platelet transfusion in adult patients. METHODS These guidelines are based on a systematic review of randomized, clinical trials and observational studies (1900 to September 2014) that reported clinical outcomes on patients receiving prophylactic or therapeutic platelet transfusions. An expert panel reviewed the data and developed recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RECOMMENDATION 1 The AABB recommends that platelets should be transfused prophylactically to reduce the risk for spontaneous bleeding in hospitalized adult patients with therapy-induced hypoproliferative thrombocytopenia. The AABB recommends transfusing hospitalized adult patients with a platelet count of 10 × 109 cells/L or less to reduce the risk for spontaneous bleeding. The AABB recommends transfusing up to a single apheresis unit or equivalent. Greater doses are not more effective, and lower doses equal to one half of a standard apheresis unit are equally effective. (Grade: strong recommendation; moderate-quality evidence). RECOMMENDATION 2 The AABB suggests prophylactic platelet transfusion for patients having elective central venous catheter placement with a platelet count less than 20 × 109 cells/L. (Grade: weak recommendation; low-quality evidence). RECOMMENDATION 3 The AABB suggests prophylactic platelet transfusion for patients having elective diagnostic lumbar puncture with a platelet count less than 50 × 109 cells/L. (Grade: weak recommendation; very-low-quality evidence). RECOMMENDATION 4 The AABB suggests prophylactic platelet transfusion for patients having major elective nonneuraxial surgery with a platelet count less than 50 × 109 cells/L. (Grade: weak recommendation; very-low-quality evidence). RECOMMENDATION 5 The AABB recommends against routine prophylactic platelet transfusion for patients who are nonthrombocytopenic and have cardiac surgery with cardiopulmonary bypass. The AABB suggests platelet transfusion for patients having bypass who exhibit perioperative bleeding with thrombocytopenia and/or evidence of platelet dysfunction. (Grade: weak recommendation; very-low-quality evidence). RECOMMENDATION 6 The AABB cannot recommend for or against platelet transfusion for patients receiving antiplatelet therapy who have intracranial hemorrhage (traumatic or spontaneous). (Grade: uncertain recommendation; very-low-quality evidence).
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Affiliation(s)
- Richard M. Kaufman
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Benjamin Djulbegovic
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Terry Gernsheimer
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Steven Kleinman
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Alan T. Tinmouth
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Kelley E. Capocelli
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Mark D. Cipolle
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Claudia S. Cohn
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Mark K. Fung
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Brenda J. Grossman
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Paul D. Mintz
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Barbara A. O'Malley
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Deborah A. Sesok-Pizzini
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Aryeh Shander
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Gary E. Stack
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Kathryn E. Webert
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Robert Weinstein
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Babu G. Welch
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Glenn J. Whitman
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Edward C. Wong
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
| | - Aaron A.R. Tobian
- From Brigham and Women's Hospital, Boston, Massachusetts; University of South Florida, Tampa, Florida; University of Washington, Seattle, Washington; University of British Columbia, Vancouver, British Columbia, Canada; Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Children's Hospital Colorado, Aurora, Colorado; Christiana Care Health System, Wilmington, Delaware; University of Minnesota, Minneapolis, Minnesota; University of Vermont, Burlington, Vermont
- Washington University School of Medicine, St. Louis, Missouri; U.S. Food and Drug Administration, Silver Spring, Maryland; Wayne State University, Detroit, Michigan; The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Englewood Hospital and Medical Center, Englewood, New Jersey; Yale School of Medicine, New Haven, Connecticut; McMaster University, Hamilton, Ontario, Canada; University of Massachusetts School of Medicine, Worcester, Massachusetts
- University of Texas Southwestern Medical Center, Dallas, Texas; Johns Hopkins University, Baltimore, Maryland; and Children's National Medical Center, Washington, DC
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Kaplan I, Allon I, Shlomi B, Raiser V, Kleinman S, Allon D. A comparative study of oral hamartoma and choristoma. Oral Surg Oral Med Oral Pathol Oral Radiol 2014. [DOI: 10.1016/j.oooo.2014.05.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kumar A, Mhaskar R, Grossman BJ, Kaufman RM, Tobian AA, Kleinman S, Gernsheimer T, Tinmouth AT, Djulbegovic B. Platelet transfusion: a systematic review of the clinical evidence. Transfusion 2014; 55:1116-27; quiz 1115. [DOI: 10.1111/trf.12943] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Revised: 10/09/2014] [Accepted: 10/09/2014] [Indexed: 12/20/2022]
Affiliation(s)
- Ambuj Kumar
- Division of Evidence-Based Medicine; Department of Internal Medicine; Morsani College of Medicine; University of South Florida; Tampa Florida
- Moffitt Cancer Center; Tampa Florida
| | - Rahul Mhaskar
- Division of Evidence-Based Medicine; Department of Internal Medicine; Morsani College of Medicine; University of South Florida; Tampa Florida
| | | | | | | | - Steven Kleinman
- Center for Blood Research; The University of British Columbia; Vancouver British Columbia Canada
| | - Terry Gernsheimer
- University of Washington Medical Center and Seattle Cancer Care Alliance; Seattle Washington
| | | | - Benjamin Djulbegovic
- Division of Evidence-Based Medicine; Department of Internal Medicine; Morsani College of Medicine; University of South Florida; Tampa Florida
- Moffitt Cancer Center; Tampa Florida
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Kleinman S, Busch MP, Murphy EL, Shan H, Ness P, Glynn SA. The National Heart, Lung, and Blood Institute Recipient Epidemiology and Donor Evaluation Study (REDS-III): a research program striving to improve blood donor and transfusion recipient outcomes. Transfusion 2013; 54:942-55. [PMID: 24188564 DOI: 10.1111/trf.12468] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 09/11/2013] [Accepted: 09/11/2013] [Indexed: 12/29/2022]
Abstract
BACKGROUND The Recipient Epidemiology and Donor Evaluation Study-III (REDS-III) is a 7-year multicenter transfusion safety research initiative launched in 2011 by the National Heart, Lung, and Blood Institute. STUDY DESIGN AND METHODS The domestic component involves four blood centers, 12 hospitals, a data coordinating center, and a central laboratory. The international component consists of distinct programs in Brazil, China, and South Africa, which involve US and in-country investigators. RESULTS REDS-III is using two major methods to address key research priorities in blood banking and transfusion medicine. First, there will be numerous analyses of large "core" databases; the international programs have each constructed a donor and donation database while the domestic program has established a detailed research database that links data from blood donors and their donations, the components made from these donations, and data extracts from the electronic medical records of the recipients of these components. Second, there are more than 25 focused research protocols involving transfusion recipients, blood donors, or both that either are in progress or are scheduled to begin within the next 3 years. Areas of study include transfusion epidemiology and blood utilization, transfusion outcomes, noninfectious transfusion risks, human immunodeficiency virus-related safety issues (particularly in the international programs), emerging infectious agents, blood component quality, donor health and safety, and other donor issues. CONCLUSIONS It is intended that REDS-III serve as an impetus for more widespread recipient and linked donor-recipient research in the United States as well as to help assure a safe and available blood supply in the United States and in international locations.
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Affiliation(s)
- Steven Kleinman
- Department of Pathology, University of British Columbia, Victoria, British Columbia, Canada
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Bruhn R, Lelie N, Custer B, Busch M, Kleinman S. Prevalence of human immunodeficiency virus RNA and antibody in first-time, lapsed, and repeat blood donations across five international regions and relative efficacy of alternative screening scenarios. Transfusion 2013; 53:2399-412. [DOI: 10.1111/trf.12299] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Revised: 04/17/2013] [Accepted: 04/17/2013] [Indexed: 12/18/2022]
Affiliation(s)
- Roberta Bruhn
- Blood Systems Research Institute; Lelie Research; San Francisco California Paris France
- University of British Columbia; Canada
| | - Nico Lelie
- Blood Systems Research Institute; Lelie Research; San Francisco California Paris France
- University of British Columbia; Canada
| | - Brian Custer
- Blood Systems Research Institute; Lelie Research; San Francisco California Paris France
- University of British Columbia; Canada
| | - Michael Busch
- Blood Systems Research Institute; Lelie Research; San Francisco California Paris France
- University of British Columbia; Canada
| | - Steven Kleinman
- Blood Systems Research Institute; Lelie Research; San Francisco California Paris France
- University of British Columbia; Canada
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Spencer BR, Kleinman S, Wright DJ, Glynn SA, Rye DB, Kiss JE, Mast AE, Cable RG. Restless legs syndrome, pica, and iron status in blood donors. Transfusion 2013; 53:1645-52. [PMID: 23763445 DOI: 10.1111/trf.12260] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Revised: 04/14/2013] [Accepted: 04/14/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND The association of blood donation-related iron deficiency with pica or restless legs syndrome (RLS) remains poorly elucidated. This study evaluated the prevalence of RLS and pica in blood donors completing the REDS-II Iron Status Evaluation (RISE) study. STUDY DESIGN AND METHODS RISE enrolled 2425 blood donors in a prospective cohort study; 1334 donors provided blood samples to characterize iron status and answered a questionnaire inquiring into symptoms of RLS and pica at a final visit after 15 to 24 months of follow-up. Associations between both conditions and iron status were evaluated. RESULTS There were 9 and 20% of donors reporting symptoms of probable or probable/possible RLS, respectively. Iron depletion and donation intensity were not predictive of RLS. Pica was reported by 65 donors (5.5%), half of whom reported daily cravings. Prevalence of pica increased with degree of iron depletion in women (2% in iron-replete females, 13% in those with ferritin < 12 ng/mL), but not in men. Probable RLS and pica coexpressed in eight individuals, but no more frequently than expected by chance. CONCLUSION RLS and pica have been associated with iron deficiency in nondonor populations. This study indicates a potentially high prevalence of RLS in frequent blood donors but shows no association with iron status or donation intensity. Low iron stores were associated with higher prevalence of pica, but only in females. Furthermore, the results are incompatible with RLS and pica sharing a common pathophysiology.
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Affiliation(s)
- Bryan R Spencer
- American Red Cross Blood Services, New England Region, Dedham, Massachusetts 02026, USA.
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Kleinman S, Reed W, Stassinopoulos A. A patient-oriented risk-benefit analysis of pathogen-inactivated blood components: application to apheresis platelets in the United States. Transfusion 2012; 53:1603-18. [DOI: 10.1111/j.1537-2995.2012.03928.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 08/24/2012] [Accepted: 08/25/2012] [Indexed: 12/21/2022]
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Kleinman S, King MR, Busch MP, Murphy EL, Glynn SA. The National Heart, Lung, and Blood Institute retrovirus epidemiology donor studies (Retrovirus Epidemiology Donor Study and Retrovirus Epidemiology Donor Study-II): twenty years of research to advance blood product safety and availability. Transfus Med Rev 2012; 26:281-304, 304.e1-2. [PMID: 22633182 PMCID: PMC3448800 DOI: 10.1016/j.tmrv.2012.04.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The Retrovirus Epidemiology Donor Study (REDS), conducted from 1989 to 2001, and the REDS-II, conducted from 2004 to 2012, were National Heart, Lung, and Blood Institute-funded, multicenter programs focused on improving blood safety and availability in the United States. The REDS-II also included international study sites in Brazil and China. The 3 major research domains of REDS/REDS-II have been infectious disease risk evaluation, blood donation availability, and blood donor characterization. Both programs have made significant contributions to transfusion medicine research methodology by the use of mathematical modeling, large-scale donor surveys, innovative methods of repository sample storage, and establishing an infrastructure that responded to potential emerging blood safety threats such as xenotropic murine leukemia virus-related virus. Blood safety studies have included protocols evaluating epidemiologic and/or laboratory aspects of human immunodeficiency virus, human T-lymphotropic virus 1/2, hepatitis C virus, hepatitis B virus, West Nile virus, cytomegalovirus, human herpesvirus 8, parvovirus B19, malaria, Creutzfeldt-Jakob disease, influenza, and Trypanosoma cruzi infections. Other analyses have characterized blood donor demographics, motivations to donate, factors influencing donor return, behavioral risk factors, donors' perception of the blood donation screening process, and aspects of donor deferral. In REDS-II, 2 large-scale blood donor protocols examined iron deficiency in donors and the prevalence of leukocyte antibodies. This review describes the major study results from over 150 peer-reviewed articles published by these 2 REDS programs. In 2011, a new 7-year program, the Recipient Epidemiology and Donor Evaluation Study-III, was launched. The Recipient Epidemiology and Donor Evaluation Study-III expands beyond donor-based research to include studies of blood transfusion recipients in the hospital setting and adds a third country, South Africa, to the international program.
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Affiliation(s)
- Steven Kleinman
- Department of Pathology, University of British Columbia, Victoria, British Columbia, Canada.
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Gottschall J, Triulzi D, Kakaiya R, Carrick D, Roback JD, Carey P, Kleinman S. Human neutrophil antibodies in a blood donor population: a lookback study. Vox Sang 2012; 104:166-70. [PMID: 22998453 DOI: 10.1111/j.1423-0410.2012.01651.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND OBJECTIVES Human neutrophil antibodies (HNA) have been associated with severe transfusion-related acute lung injury (TRALI). We identified HNA antibodies in a blood donor population and performed an observational lookback on patients who received products from these donors to determine whether TRALI was associated with these transfusions. MATERIALS AND METHODS Human neutrophil antibodies were determined in 1171 blood donors (388 non-transfused males, 390 human leucocyte antigen (HLA) antibody-negative females and 393 HLA antibody-positive females) for IgG and IgM antibodies using a flow cytometric assay. Selected positive samples had a monoclonal antibody immobilization of granulocyte antigen (MAIGA) and neutrophil genotyping performed to confirm specificity. Lookback was performed on patients receiving blood from donors with positive samples by extracting recipient data from hospital medical records. An expert panel of three pulmonary critical care physicians reviewed the summarized data and assigned a diagnosis of TRALI, possible TRALI, cannot distinguish between TRALI and TACO, TACO and other. RESULTS Eight donors had HNA antibodies of which five contributed to this lookback (3-HNA-specific antibodies, 2-HNA non-specific antibodies). Seventy-six blood products were transfused from these donors into individual patients. One patient developed TRALI that was associated with a donor with a non-specific HNA antibody as well as class-I and class-II HLA antibodies. CONCLUSION The incidence of TRALI in this lookback was low and combined with low frequency of HNA antibodies in the donor population suggests not screening donors for HNA antibodies at this time is acceptable.
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Affiliation(s)
- J Gottschall
- BloodCenter of Wisconsin, Medical College of Wisconsin, Milwaukee, WI 53233, USA.
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Carson JL, Grossman BJ, Kleinman S, Tinmouth AT, Marques MB, Fung MK, Holcomb JB, Illoh O, Kaplan LJ, Katz LM, Rao SV, Roback JD, Shander A, Tobian AAR, Weinstein R, Swinton McLaughlin LG, Djulbegovic B. Red blood cell transfusion: a clinical practice guideline from the AABB*. Ann Intern Med 2012; 157:49-58. [PMID: 22751760 DOI: 10.7326/0003-4819-157-1-201206190-00429] [Citation(s) in RCA: 707] [Impact Index Per Article: 58.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
DESCRIPTION Although approximately 85 million units of red blood cells (RBCs) are transfused annually worldwide, transfusion practices vary widely. The AABB (formerly, the American Association of Blood Banks) developed this guideline to provide clinical recommendations about hemoglobin concentration thresholds and other clinical variables that trigger RBC transfusions in hemodynamically stable adults and children. METHODS These guidelines are based on a systematic review of randomized clinical trials evaluating transfusion thresholds. We performed a literature search from 1950 to February 2011 with no language restrictions. We examined the proportion of patients who received any RBC transfusion and the number of RBC units transfused to describe the effect of restrictive transfusion strategies on RBC use. To determine the clinical consequences of restrictive transfusion strategies, we examined overall mortality, nonfatal myocardial infarction, cardiac events, pulmonary edema, stroke, thromboembolism, renal failure, infection, hemorrhage, mental confusion, functional recovery, and length of hospital stay. RECOMMENDATION 1: The AABB recommends adhering to a restrictive transfusion strategy (7 to 8 g/dL) in hospitalized, stable patients (Grade: strong recommendation; high-quality evidence). RECOMMENDATION 2: The AABB suggests adhering to a restrictive strategy in hospitalized patients with preexisting cardiovascular disease and considering transfusion for patients with symptoms or a hemoglobin level of 8 g/dL or less (Grade: weak recommendation; moderate-quality evidence). RECOMMENDATION 3: The AABB cannot recommend for or against a liberal or restrictive transfusion threshold for hospitalized, hemodynamically stable patients with the acute coronary syndrome (Grade: uncertain recommendation; very low-quality evidence). RECOMMENDATION 4: The AABB suggests that transfusion decisions be influenced by symptoms as well as hemoglobin concentration (Grade: weak recommendation; low-quality evidence).
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Affiliation(s)
- Jeffrey L Carson
- MD, Division of General Internal Medicine, UMDNJ–Robert Wood Johnson Medical School, 125 Paterson Street, New Brunswick, NJ 08903, USA.
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Reesink HW, Lee J, Keller A, Dennington P, Pink J, Holdsworth R, Schennach H, Goldman M, Petraszko T, Sun J, Meng Y, Qian K, Rehacek V, Turek P, Krusius T, Juvonen E, Tiberghien P, Legrand D, Semana G, Muller JY, Bux J, Reil A, Lin CK, Daly H, McSweeney E, Porretti L, Greppi N, Rebulla P, Okazaki H, Sánchez-Guerrero SA, Baptista-González HA, Martínez-Murillo C, Guerra-Márquez A, Rodriguez-Moyado H, Middelburg RA, Wiersum-Osselton JC, Brand A, van Tilburg C, Dinesh D, Dagger J, Dunn P, Brojer E, Letowska M, Maslanka K, Lachert E, Uhrynowska M, Zhiburt E, Palfi M, Berlin G, Frey BM, Puig Rovira L, Muñiz-Diaz E, Castro E, Chapman C, Green A, Massey E, Win N, Williamson L, Silliman CC, Chaffin DJ, Ambruso DR, Blumberg N, Tomasulo P, Land KJ, Norris PJ, Illoh OC, Davey RJ, Benjamin RJ, Eder AF, McLaughlin L, Kleinman S, Panzer S. Measures to prevent transfusion-related acute lung injury (TRALI). Vox Sang 2012; 103:231-59. [DOI: 10.1111/j.1423-0410.2012.01596.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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