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Scully M, Rayment R, Clark A, Westwood JP, Cranfield T, Gooding R, Bagot CN, Taylor A, Sankar V, Gale D, Dutt T, McIntyre J, Lester W. A British Society for Haematology Guideline: Diagnosis and management of thrombotic thrombocytopenic purpura and thrombotic microangiopathies. Br J Haematol 2023; 203:546-563. [PMID: 37586700 DOI: 10.1111/bjh.19026] [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: 04/25/2023] [Revised: 07/21/2023] [Accepted: 07/26/2023] [Indexed: 08/18/2023]
Abstract
The objective of this guideline is to provide healthcare professionals with clear, up-to-date and practical guidance on the management of thrombotic thrombocytopenic purpura (TTP) and related thrombotic microangiopathies (TMAs), including complement-mediated haemolytic uraemic syndrome (CM HUS); these are defined by thrombocytopenia, microangiopathic haemolytic anaemia (MAHA) and small vessel thrombosis. Within England, all TTP cases should be managed within designated regional centres as per NHSE commissioning for highly specialised services.
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Affiliation(s)
- M Scully
- Department of Haematology, UCLH and Haematology Programme, University College London Hospitals Biomedical Research Centre, National Institute for Health Research, London, UK
| | - R Rayment
- Department of Haematology, University Hospital of Wales, Cardiff, UK
| | - A Clark
- Department of Haematology, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - T Cranfield
- Department of Haematology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
| | - R Gooding
- Haematology Department, Belfast City Hospital, Belfast H&SC Trust, Belfast, UK
| | - C N Bagot
- Glasgow Royal Infirmary, Glasgow, UK
| | - A Taylor
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - V Sankar
- Department of Critical Care Medicine, Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - D Gale
- Department of Renal Medicine, University College London, London, UK
| | - T Dutt
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - W Lester
- Department of Haematology, University Hospitals Birmingham, Birmingham, UK
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Mehrotra A, Bhushan B, Kumar A, Panigrahi M, Chauhan A, Kumari S, Saini BL, Dutt T, Mishra BP. Characterisation and comparison of immune response mechanisms in an indigenous and a commercial pig breed after classical swine fever vaccination. Anim Genet 2021; 53:68-79. [PMID: 34729794 DOI: 10.1111/age.13152] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 04/13/2021] [Revised: 08/29/2021] [Accepted: 10/14/2021] [Indexed: 01/27/2023]
Abstract
The live attenuated classical swine fever (CSF) vaccine has been successfully used to prevent and control CSF outbreaks for 6 decades. However, the immune response mechanisms against the vaccine remain poorly understood. Moreover, very few reports exist regarding the breed differences in the response to CSF vaccine. In this study, we generated the peripheral blood mononuclear cell transcriptomes of indigenous Ghurrah and commercial Landrace pig breeds, before and 7 days after CSF vaccination. Subsequently, between and within-breed differential gene expression analyses were carried out. Results revealed large differences in pre-vaccination peripheral blood mononuclear cell transcriptome profiles of the two breeds, which were homogenised 7 days after vaccination. Before vaccination, gene set enrichment analysis showed that pathways related to antigen sensing and innate immune response were enriched in Ghurrah, while pathways related to adaptive immunity were enriched in Landrace. Ghurrah exhibited greater immunomodulation compared to Landrace following the vaccination. In Ghurrah, cell-cycle processes and T-cell response pathways were upregulated after vaccination. However, no pathways were upregulated in Landrace after vaccination. Pathways related to inflammation were downregulated in both the breeds after vaccination. Key regulators of inflammation such as IL1A, IL1B, NFKBIA and TNF genes were strongly downregulated in both the breeds after vaccination. Overall, our results have elucidated the mechanisms of host immune response against CSF vaccination in two distinct breeds and revealed common key genes instrumental in the global immune response to the vaccine.
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Affiliation(s)
- A Mehrotra
- Division of Animal Genetics, ICAR - Indian Veterinary Research Institute, Izatnangar, Bareilly, UP, 243122, India
| | - B Bhushan
- Division of Animal Genetics, ICAR - Indian Veterinary Research Institute, Izatnangar, Bareilly, UP, 243122, India
| | - A Kumar
- Division of Animal Genetics, ICAR - Indian Veterinary Research Institute, Izatnangar, Bareilly, UP, 243122, India
| | - M Panigrahi
- Division of Animal Genetics, ICAR - Indian Veterinary Research Institute, Izatnangar, Bareilly, UP, 243122, India
| | - A Chauhan
- Division of Livestock Production and Management, ICAR - Indian Veterinary Research Institute, Izatnangar, Bareilly, UP, 243122, India
| | - S Kumari
- Division of Animal Genetics, ICAR - Indian Veterinary Research Institute, Izatnangar, Bareilly, UP, 243122, India
| | - B L Saini
- Division of Animal Genetics, ICAR - Indian Veterinary Research Institute, Izatnangar, Bareilly, UP, 243122, India
| | - T Dutt
- Division of Livestock Production and Management, ICAR - Indian Veterinary Research Institute, Izatnangar, Bareilly, UP, 243122, India
| | - B P Mishra
- Animal Biotechnology, ICAR - Indian Veterinary Research Institute, Izatnangar, Bareilly, UP, 243122, India
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Langley K, Fretwell R, Kitchen S, MacDonald S, Dutt T, Baker P, Singh D, McDonald V, Hughes C, Murphy P, Scully M. Multiple centre evaluation study of ADAMTS13 activity and inhibitor assays. Int J Lab Hematol 2017; 40:21-25. [DOI: 10.1111/ijlh.12718] [Citation(s) in RCA: 4] [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: 04/18/2017] [Accepted: 06/16/2017] [Indexed: 11/26/2022]
Affiliation(s)
- K. Langley
- Haemostasis Research Unit; University College London; London UK
| | | | - S. Kitchen
- Royal Hallamshire Hospital; Sheffield UK
| | | | - T. Dutt
- Royal Liverpool University Hospital; Liverpool UK
| | - P. Baker
- Oxford Haemophilia and Thrombosis Centre; Oxford UK
| | - D. Singh
- The Doctors Laboratory Ltd; London UK
| | - V. McDonald
- Centre for Haemostasis and Thrombosis St Thomas’ Hospital; London UK
| | - C. Hughes
- St James's University Hospital; Leeds UK
| | - P. Murphy
- Newcastle upon Tyne Hospitals Foundation Trust; Newcastle UK
| | - M. Scully
- University College London Hospitals; London UK
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Johnson PJ, Dutt T, Renton BJ. Electronic Prompts Can Reduce The Number Of Unnecessary Clotting Screens Ordered For Patients. Acute Med 2017; 16:107-110. [PMID: 29072868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
In an attempt to reduce the number of inappropriate clotting screens being performed in our Trust, an electronic prompt was introduced to our haematology requesting system. Over the six month period after introduction of this prompt the number of clotting screen requests reduced by 7001, representing a 21% reduction when compared to the same 6 month period one year earlier. This represented a cost saving of over £98,000 without any increase in adverse incidents being reported related to bleeding complications.
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Affiliation(s)
- P J Johnson
- Acute Care Common Stem Trainee, Royal Liverpool University Hospital
| | - T Dutt
- Consultant Haematologist, Royal Liverpool University Hospital
| | - B J Renton
- Consultant in Acute Medicine, Royal Liverpool University Hospital
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Kaswan S, Patel B, Mondal S, Dutt T, Verma M, Verma A, Upadhyay D. Effect of reduced floor space allowances on performance of crossbred weaner barrows. INDIAN J ANIM RES 2015. [DOI: 10.5958/0976-0555.2015.00036.9] [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: 10/23/2022]
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Upadhyay D, Patel B, Kerketta S, Kaswan S, Sahu S, Bhushan B, Dutt T. Study on udder morphology and its relationship with production parameters in local goats of Rohilkhand region of India. INDIAN J ANIM RES 2014. [DOI: 10.5958/0976-0555.2014.00042.9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Dutt T, Burns S, Mackett N, Benfield C, Lwin R, Keenan R. Application of UKHCDO 2004 guidelines in type 1 von Willebrand Disease--a single centre paediatric experience of the implications of altered or removed diagnosis. Haemophilia 2011; 17:522-6. [PMID: 21371186 DOI: 10.1111/j.1365-2516.2010.02452.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Diagnosis of type I von Willebrand Disease (VWD) can be challenging. In 2004, the United Kingdom Haemophilia Centre Doctors' Organisation (UKHCDO) proposed more stringent diagnostic criteria to replace the 1995 guidelines. To determine the true number of cases of type 1 VWD in a single paediatric centre, the 2004 UKHCDO Guideline for the diagnosis of VWD was used to evaluate 114 patients on our type 1 VWD register. Clinical and laboratory data were collected and analysed to see whether they met the criteria for type 1 VWD. Only 8% remained on the type 1 VWD register. 18% have been classified as 'possible type 1 VWD'. Twenty five surgical procedures have since been performed on patients from the group in which the diagnosis was removed without any haemostatic support or bleeding complications. Reaction to the removal of the VWD diagnosis or delivery of an alternative diagnosis was positive for most patients and families. This study is the first to assess the impact of the 2004 UKHCDO Guidelines on the diagnosis of VWD. It provides evidence that the prevalence of type 1 VWD may actually be closer to that of haemophilia instead of the previously reported 1-3% of the general population. We propose that all centres should review their patients with a diagnosis of VWD to revalidate this disease that claims to be our most common inherited bleeding disorder.
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Affiliation(s)
- T Dutt
- Haematology Treatment Centre, Alder Hey Children's NHS Foundation Trust, Eaton Road, West Derby, Liverpool, UK
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Sahoo A, Chaudhary LC, Agarwal N, Kamra DN, Dutt T, Pathak NN. Effect of Replacing Cereal Grain in Concentrate With Wheat Bran on the Performance of Lactating Bos indicus x Bos taurus Cows Fed Green Fodder ad libitum in the Northern Plains of India. Asian Australas J Anim Sci 2000. [DOI: 10.5713/ajas.2000.1699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Kalra A, Bhatia R, Kalra K, Dayal RS, Dutt T, Pandey DJ, Singh YP, Misra MN. Ocular manifestations in mentally retarded children. Indian Pediatr 1987; 24:409-13. [PMID: 3679492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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