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Langi Sasongko P, van Kraaij M, So‐Osman C. Using a scenario approach to assess for the current and future demand of immunoglobulins: An interview and literature study from The Netherlands. Transfus Med 2022; 32:410-421. [PMID: 35751376 PMCID: PMC9795925 DOI: 10.1111/tme.12889] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/02/2022] [Accepted: 05/13/2022] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To explore the current and future demand of immunoglobulins globally and specifically for the Netherlands by assessing: (I) which specialties contribute to current demand, (II) new areas of medical need, (III) which transformational factors may impact demand and to what effect, by using a scenario approach. BACKGROUND As immunoglobulin demand continues to increase globally, there is concern of increasing shortages and questions of whether and how future demand will continue based on medical need. METHODS/MATERIALS In line with scenario principles, a scoping review of Pubmed, Web of Science, Embase and Cochrane and grey literature was conducted. Semi-structured interviews with subject matter experts were held. The results of the review and interviews were analysed for major themes. RESULTS The scoping review resulted in 97 articles, 74 regarding clinical uses, and 23 regarding organisational and other themes. Fifteen clinical and non-clinical experts were interviewed. I) Neurology, immunology, and haematology were specialties that contribute most to current demand. II) Regarding potential new areas of medical need, the literature review resulted in more indications than the interviews, for example, post-renal transplants. III) Four groups of key transformational factors were found: factors that could increase immunoglobulin demand (e.g., EMA revisions), decrease demand (e.g., replacement products, Dutch Transfer Act 2021), factors that remain to be seen how it impacts demand (e.g., further evidence), and miscellaneous factors (e.g., supply-related). CONCLUSION Having identified the specialties and relevant transformational factors that affect immunoglobulin demand, more research is needed on what clinical or organisational strategies would be effective in controlling demand in general for the Netherlands and abroad. Other blood establishments may also use a scenario approach to increase preparedness for future (un)expected developments.
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Affiliation(s)
- Praiseldy Langi Sasongko
- Department of Donor Medicine ResearchUnits Transfusion Technology Assessment and Donor Studies, Sanquin ResearchAmsterdamThe Netherlands,Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | | | - Cynthia So‐Osman
- Department of Unit Transfusion MedicineSanquin Blood BankAmsterdamThe Netherlands,Department of HaematologyErasmus Medical CenterRotterdamThe Netherlands
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2
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Langi Sasongko P, van den Hurk K, van Kraaij M, Rouwette EAJA, Marchau VAWJ, Janssen MP. Not a crystal ball: Mapping opportunities and threats for the future demand of red blood cells in the Netherlands using a scenario approach. Transfusion 2021; 61:2356-2367. [PMID: 34058022 DOI: 10.1111/trf.16532] [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] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/29/2021] [Accepted: 04/29/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND As Western blood transfusion practices are changing, there is interest and need in anticipating the future demand of blood products and how a blood establishment can actively prepare for various long-term developments. This article provides an overview of how a scenario approach was used to prioritize key categories of drivers for the future demand of red blood cells and the organizational implications thereof for Sanquin, the Dutch national blood establishment. STUDY DESIGN AND METHODS Based on previously identified drivers from interviews and a literature review (Step 1), we conducted scenario sessions and a survey to rank a list of drivers ("themes") with its related opportunities and threats (Step 2), to identify mitigating measures per theme through focus groups (Step 3). RESULTS In Step 2, 10 themes were found that were classified in terms of importance and uncertainty. These were plotted on a two-dimensional graph with an ellipse to indicate the interquartile ranges per theme. Experts rated the top three most important themes to be the blood supply organization, precision medicine, and red blood cell replacements. In Step 3, focus groups identified specific mitigating measures per theme. These measures had parallel ideas, such as the need for an innovative mentality, internal and external communication and collaboration, and building Sanquin's reputation and trust with the public. CONCLUSION Having identified the most important themes with suggestions for mitigating measures, Sanquin can take steps to become adaptive and proactive. Other blood establishments may also use a scenario approach to create contextualized long-term strategies.
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Affiliation(s)
- Praiseldy Langi Sasongko
- Department of Donor Medicine Research, Transfusion Technology Assessment, Sanquin Research, Amsterdam, The Netherlands.,Department of Donor Medicine Research, Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Katja van den Hurk
- Department of Donor Medicine Research, Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Marian van Kraaij
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Mart P Janssen
- Department of Donor Medicine Research, Transfusion Technology Assessment, Sanquin Research, Amsterdam, The Netherlands
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3
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Rombout-Sestrienkova E, Winkens B, van Kraaij M, van Deursen CTBM, Janssen MCH, Rennings AMJ, Evers D, Kerkhoffs JL, Masclee A, Koek GH. A predictive model for estimating the number of erythrocytapheresis or phlebotomy treatments for patients with naïve hereditary hemochromatosis. J Clin Apher 2020; 36:340-347. [PMID: 33368569 PMCID: PMC8247321 DOI: 10.1002/jca.21867] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 01/01/2023]
Abstract
Background and Aims Standard treatment for naïve hereditary hemochromatosis patients consists of phlebotomy or a personalized erythrocytapheresis. Erythrocytapheresis is more efficient, but infrequently used because of perceived costs and specialized equipment being needed. The main aim of our study was to develop a model that predicts the number of initial treatment procedures for both treatment methods. This information may help the clinician to select the optimal treatment modality for the individual patient. Methods We analyzed retrospective data of 125 newly diagnosed patients (C282Y homozygous), treated either with phlebotomy (n = 54) or erythrocytapheresis (n = 71) until serum ferritin (SF) reached levels ≤100 μg/L. To estimate the required number of treatment procedures multiple linear regression analysis was used for each treatment method separately. Results The linear regression model with the best predictive quality (R2 = 0.74 and 0.73 for erythrocytapheresis and phlebotomy respectively) included initial SF, initial hemoglobin (Hb) level, age, and BMI, where initial SF was independently related to the total number of treatment procedures for both treatment methods. The prediction error expressed in RMSPE and RMSDR was lower for erythrocytapheresis than for phlebotomy (3.8 and 4.1 vs 7.0 and 8.0 respectively), Conclusions Although the prediction error of the developed model was relatively large, the model may help the clinician to choose the most optimal treatment method for an individual patient. Generally erythrocytapheresis halves the number of treatment procedures for all patients, where the largest reduction (between 55% and 64%) is reached in patients with an initial Hb level ≥ 9 mmol/L (14.5 g/dL). ClinicalTrials.gov number NCT00202436.
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Affiliation(s)
- Eva Rombout-Sestrienkova
- Department of Transfusion Medicine, Sanquin Blood Supply, Blood Bank Division, Amsterdam, The Netherlands.,Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Bjorn Winkens
- Department of Methodology and statistics, Maastricht University, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Marian van Kraaij
- Department of Transfusion Medicine, Sanquin Blood Supply, Blood Bank Division, Amsterdam, The Netherlands
| | | | - Mirian C H Janssen
- Department of General Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.,Department of Pediatrics, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Alexander M J Rennings
- Department of General Internal Medicine, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Dorothea Evers
- Department of Immuno-hematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands.,Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
| | - Jean-Louis Kerkhoffs
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands.,Department of Hematology, HAGA Teaching Hospital, The Hague, The Netherlands
| | - Ad Masclee
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ger H Koek
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Maastricht University Medical Center, Maastricht, The Netherlands
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4
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Sandner S, Merz EM, van den Hurk K, van Kraaij M, Mikkelsen C, Ullum H, Clement M. Validation of a standardized donor health questionnaire across substances of human origin. Vox Sang 2020; 116:645-655. [PMID: 33326613 DOI: 10.1111/vox.13054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/29/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES A donor health questionnaire (DHQ) aims to ensure the safety of donors and recipients of transfusions or transplantations with blood components, plasma-derived medicinal products, tissues, haematopoietic stem cells and medically assisted reproduction (in short substances of human origin; SoHO). Currently, many different DHQs exist across countries and SoHO. TRANSPOSE (TRANSfusion and transplantation PrOtection and SElection of donors) developed and validated a standardized DHQ to use across countries and SoHO. We tested whether participants understand the questions and provide honest answers. METHODS For the validation of the standardized DHQ, two demographically representative online surveys were conducted in Germany (N = 3329) and Austria (N = 3432). We surveyed whether participants understood each DHQ question and would answer the questions truthfully. We used experimental settings to test whether there is a difference between mode of administration (print vs. online), the order of the questions (subject vs. chronological order), and the positioning of the general state of health question (beginning vs. end) in the DHQ. Using regression models, we tested the DHQ's impact on participant mood after completion and on socially desirable response behaviour. RESULTS Participants understood the DHQ questions well and would answer them honestly. Nevertheless, the data show different levels of understanding and honesty when responding. Administration mode was the only characteristic that had a significant influence on mood, with the online version resulting in a more favourable mood in comparison to the printed version. CONCLUSION The DHQ was well understood and had a low dishonest tendency. Our findings can serve as an impulse for further research on DHQ criteria across other SoHO and countries.
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Affiliation(s)
- Sabrina Sandner
- Research Group on Health Marketing, Institute for Marketing, University of Hamburg, Hamburg, Germany
| | - Eva-Maria Merz
- Research Group on Donor Studies, Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands.,Center for Philanthropic Studies, Department of Sociology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Katja van den Hurk
- Research Group on Donor Studies, Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Marian van Kraaij
- Research Group on Donor Studies, Department of Donor Medicine Research, Sanquin Research, Amsterdam, The Netherlands
| | - Christina Mikkelsen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Michel Clement
- Research Group on Health Marketing, Institute for Marketing, University of Hamburg, Hamburg, Germany
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5
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Mikkelsen C, Mori G, van Walraven SM, Castrén J, Zahra S, MacLennan S, Seidel K, Fontana S, Veropalumbo E, Cannata L, Pupella S, Kvist M, Happel M, Korkalainen P, Chandrasekar A, Paulus U, Bokhorst A, Wulff B, Fernandez-Sojo J, Eguizabal C, Urbano F, Vesga MA, van Kraaij M, Merz EM, van den Hurk K, Hansen MB, Slot E, Ullum H. How donor selection criteria can be evaluated with limited scientific evidence: lessons learned from the TRANSPOSE project. Vox Sang 2020; 116:342-350. [PMID: 33191514 DOI: 10.1111/vox.13028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 05/29/2020] [Revised: 10/21/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND OBJECTIVE Donor selection criteria (DSC) are a vital link in the chain of supply of Substances of Human Origin (SoHO) but are also subject to controversy and differences of opinion. Traditionally, DSC have been based on application of the precautionary principle. MATERIALS AND METHODS From 2017 to 2020, TRANSPOSE (TRANSfusion and transplantation PrOtection and SElection of donors), a European research project, aimed to identify discrepancies between current DSC by proposing a standardized risk assessment method for all SoHO (solid organs excluded) and all levels of evidence. RESULTS The current DSC were assessed using a modified risk assessment method based on the Alliance of Blood Operators' Risk-based decision-making framework for blood safety. It was found that with limited or diverging scientific evidence, it was difficult to reach consensus and an international standardized method for decision-making was lacking. Furthermore, participants found it hard to disregard their local guidelines when providing expert opinion, which resulted in substantial influence on the consensus-based decision-making process. CONCLUSIONS While the field of donation-safety research is expanding rapidly, there is an urgent need to formalize the decision-making process regarding DSC. This includes the need for standardized methods to increase transparency in the international decision-making process and to ensure that this is performed consistently. Our framework provides an easy-to-implement approach for standardizing risk assessments, especially in the context of limited scientific evidence.
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Affiliation(s)
- Christina Mikkelsen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Gaia Mori
- Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | | | | | - Sharon Zahra
- Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | | | | | - Stefano Fontana
- Interregional Blood Transfusion Service SRC, University of Lausanne, Berne, Switzerland
| | - Eva Veropalumbo
- Centro Nazionale Sangue, Istituto Superiore di Sanità, Rome, Italy
| | - Livia Cannata
- Centro Nazionale Sangue, Istituto Superiore di Sanità, Rome, Italy
| | | | - Maria Kvist
- Department of Clinical Immunology and Transfusion Medicine, Karolinska University Hospital, Solna, Sweden
| | - Marjan Happel
- TRIP Hemovigilance and Biovigilance Office, Leiden, the Netherlands
| | | | | | | | - Arlinke Bokhorst
- TRIP Hemovigilance and Biovigilance Office, Leiden, the Netherlands
| | - Birgit Wulff
- Institute of Legal Medicine, University Medical Center Hamburg, Hamburg, Germany
| | | | - Cristina Eguizabal
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Fernando Urbano
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Miguel Angel Vesga
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | | | - Eva-Maria Merz
- Sanquin Research, Department of Donor Medicine Research - Donor Studies, Amsterdam, the Netherlands.,Department of Sociology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Katja van den Hurk
- Sanquin Research, Department of Donor Medicine Research - Donor Studies, Amsterdam, the Netherlands
| | - Morten Bagge Hansen
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ed Slot
- Sanquin Blood Supply Foundation, Amsterdam, the Netherlands
| | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Copenhagen, Denmark
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6
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Mikkelsen C, Mori G, van Walraven SM, Castrén J, Zahra S, MacLennan S, Seidel K, Fontana S, Veropalumbo E, Cannata L, Pupella S, Kvist M, Happel M, Korkalainen P, Wulff B, Fernandez-Sojo J, Eguizabal C, Urbano F, Vesga MA, Pozenel P, van Kraaij M, Hansen MB, Slot E, Ullum H. Putting the spotlight on donation-related risks and donor safety - are we succeeding in protecting donors? Vox Sang 2020; 116:313-323. [PMID: 33103801 DOI: 10.1111/vox.13014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 05/29/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND OBJECTIVE The European consortium project TRANSPOSE (TRANSfusion and transplantation: PrOtection and SElection of donors) aimed to assess and evaluate the risks to donors of Substances of Human Origin (SoHO), and to identify gaps between current donor vigilance systems and perceived risks. MATERIALS AND METHODS National and local data from participating organizations on serious and non-serious adverse reactions in donors were collected from 2014 to 2017. Following this, a survey was performed among participants to identify risks not included in the data sets. Finally, participants rated the risks according to severity, level of evidence and prevalence. RESULTS Significant discrepancies between anticipated donor risks and the collected data were found. Furthermore, many participants reported that national data on adverse reactions in donors of stem cells, gametes, embryos and tissues were not routinely collected and/or available. CONCLUSIONS These findings indicate that there is a need to further develop and standardize donor vigilance in Europe and to include long-term risks to donors, which are currently underreported, ensuring donor health and securing the future supply of SoHO.
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Affiliation(s)
- Christina Mikkelsen
- Department of Clinical immunology, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Gaia Mori
- Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | | | | | - Sharon Zahra
- Scottish National Blood Transfusion Service, Edinburgh, Scotland
| | | | | | - Stefano Fontana
- Interregional Blood Transfusion Service SRC, Berne and University of Lausanne, Berne, Switzerland
| | - Eva Veropalumbo
- Centro Nazionale Sangue and Istituto Superiore di Sanità, Italy
| | - Livia Cannata
- Centro Nazionale Sangue and Istituto Superiore di Sanità, Italy
| | | | - Maria Kvist
- Department of Clinical Immunology, Karolinska University Hospital, Stockholm, Sweden
| | - Marjan Happel
- TRIP Hemovigilance and Biovigilance Office, Leiden, The Netherlands
| | | | - Birgit Wulff
- Institute of Legal Medicine, University Medical Center Hamburg, Hamburg, Germany
| | | | - Cristina Eguizabal
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Fernando Urbano
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Miguel Angel Vesga
- Bioef-Fundacion Vasca de Innovacion e Investigation Sanitarias-Osakidetza-Centro Vasco de Transfusión y Tejidos Humanos, Galdakao, Spain
| | - Primoz Pozenel
- Blood transfusion Center of Slovenia, Ljubljana, Slovenia
| | | | - Morten Bagge Hansen
- Department of Clinical immunology, Copenhagen University Hospital, Kobenhavn, Denmark
| | - Ed Slot
- Sanquin Blood Supply Foundation, Amsterdam, The Netherlands
| | - Henrik Ullum
- Department of Clinical immunology, Copenhagen University Hospital, Kobenhavn, Denmark
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Hoeks M, Bagguley T, van Marrewijk C, Smith A, Bowen D, Culligan D, Kolade S, Symeonidis A, Garelius H, Spanoudakis M, Langemeijer S, Roelofs R, Wiegerinck E, Tatic A, Killick S, Panagiotidis P, Stanca O, Hellström-Lindberg E, Cermak J, van der Klauw M, Wouters H, van Kraaij M, Blijlevens N, Swinkels DW, de Witte T. Toxic iron species in lower-risk myelodysplastic syndrome patients: course of disease and effects on outcome. Leukemia 2020; 35:1745-1750. [PMID: 32948844 PMCID: PMC8179850 DOI: 10.1038/s41375-020-01022-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Marlijn Hoeks
- Centre for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands. .,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands. .,Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Tim Bagguley
- Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - Corine van Marrewijk
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Alex Smith
- Epidemiology and Cancer Statistics Group, University of York, York, UK
| | - David Bowen
- St. James's Institute of Oncology, Leeds Teaching Hospitals, Leeds, UK
| | - Dominic Culligan
- Department of Hematology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Seye Kolade
- Department of Hematology, Blackpool Victoria Hospital, Blackpool, Lancashire, UK
| | - Argiris Symeonidis
- Department of Medicine, Division of Hematology, University of Patras Medical School, Patras, Greece
| | - Hege Garelius
- Department of Medicine, Sect. of Hematology and Coagulation, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Michail Spanoudakis
- Department of Hematology, Airedale NHS Trust, Airdale, UK.,Department of Haematology, Warrington and Halton Teaching Hospitals NHS foundation Trust, Cheshire, UK
| | - Saskia Langemeijer
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rian Roelofs
- Department of Laboratory Medicine, Hepcidinanalysis.com, and Radboudumc Expertise Center for Iron Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Erwin Wiegerinck
- Department of Laboratory Medicine, Hepcidinanalysis.com, and Radboudumc Expertise Center for Iron Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Aurelia Tatic
- Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | - Sally Killick
- Department of Hematology, Royal Bournemouth Hospital, Bournemouth, UK
| | - Panagiotis Panagiotidis
- Department of Haematology, 1st Department of Propedeutic Internal Medicine, National and Kapodistrian University of Athens, Medical School, Laikon General Hospital, Athens, Greece
| | - Oana Stanca
- Department of Hematology, Coltea Clinical Hospital, Bucharest, Romania
| | - Eva Hellström-Lindberg
- Department of Medicine, Division of Hematology, Karolinska Institutet, Stockholm, Sweden
| | - Jaroslav Cermak
- Department of Clinical Hematology, Institute of Hematology and Blood Transfusion, Praha, Czech Republic
| | - Melanie van der Klauw
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Hanneke Wouters
- Department of Endocrinology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Marian van Kraaij
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nicole Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Hepcidinanalysis.com, and Radboudumc Expertise Center for Iron Disorders, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Theo de Witte
- Nijmegen Center for Molecular Life Sciences, Department of Tumor Immunology, Radboud University Medical Center, Nijmegen, The Netherlands
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8
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Vinkenoog M, van den Hurk K, van Kraaij M, van Leeuwen M, Janssen MP. First results of a ferritin-based blood donor deferral policy in the Netherlands. Transfusion 2020; 60:1785-1792. [PMID: 32533600 PMCID: PMC7496980 DOI: 10.1111/trf.15906] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 04/22/2020] [Accepted: 04/22/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Whole blood donors are at risk of becoming iron deficient. To monitor iron stores, Sanquin implemented a new deferral policy based on ferritin levels, in addition to the traditional hemoglobin measurements. METHODS Ferritin levels are determined in every fifth donation, as well as in all first-time donors. Donors with ferritin levels <15 ng/mL (WHO threshold) are deferred for 12 months; those ≥15 and ≤30 ng/mL for 6 months. The first results were analyzed and are presented here. RESULTS The results show that 25% of women (N = 20151, 95% CI 24%-25%) and 1.6% of men (N = 10391, 95% CI 1.4%-1.8%) have ferritin levels ≤30 ng/mL at their first blood center visit. For repeat (non-first-time) donors, these proportions are higher: 53% of women (N = 28329, 95% CI 52%-54%) and 42% of men (N = 31089, 95% CI 41%-43%). After a 6-month deferral, in 88% of returning women (N = 3059, 95% CI 87%-89%) and 99% of returning men (N = 3736, 95% CI 98%-99%) ferritin levels were ≥15 ng/mL. After a 12-month deferral, in 74% of returning women (N = 486, 95% CI 70%-78%) and 95% of returning men (N = 479, 95% CI 94%-97%) ferritin levels increased to ≥15 ng/mL. CONCLUSION Deferral of donors whose pre-donation ferritin levels were ≤30 ng/mL might prevent donors from returning with ferritin levels <15 ng/mL. This policy is promising to mitigate effects of repeated donations on iron stores.
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Affiliation(s)
- Marieke Vinkenoog
- Donor Medicine Research, Sanquin ResearchAmsterdamThe Netherlands
- Leiden Institute of Advanced Computer ScienceLeiden UniversityLeidenThe Netherlands
| | | | | | - Matthijs van Leeuwen
- Leiden Institute of Advanced Computer ScienceLeiden UniversityLeidenThe Netherlands
| | - Mart P. Janssen
- Donor Medicine Research, Sanquin ResearchAmsterdamThe Netherlands
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9
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Mori G, Merz E, van den Hurk K, van Walraven SM, Tiberghien P, van Kraaij M. Vers une optimisation de la sélection et de la protection des donneurs : à propos de l’étude européenne TRANSPOSE. Transfus Clin Biol 2019. [DOI: 10.1016/j.tracli.2019.06.326] [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: 11/29/2022]
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10
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Hoeks M, Yu G, Langemeijer S, Crouch S, de Swart L, Fenaux P, Symeonidis A, Čermák J, Hellström-Lindberg E, Sanz G, Stauder R, Holm MS, Mittelman M, Mądry K, Malcovati L, Tatic A, Almeida AM, Germing U, Savic A, Šimec NG, Culligan D, Itzykson R, Guerci-Bresler A, Slama B, Droste J, van Marrewijk C, van de Loosdrecht A, Blijlevens N, van Kraaij M, Bowen D, de Witte T, Smith A. Impact of treatment with iron chelation therapy in patients with lower-risk myelodysplastic syndromes participating in the European MDS registry. Haematologica 2019; 105:640-651. [PMID: 31278207 PMCID: PMC7049356 DOI: 10.3324/haematol.2018.212332] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [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: 11/19/2018] [Accepted: 07/04/2019] [Indexed: 01/19/2023] Open
Abstract
Iron overload due to red blood cell (RBC) transfusions is associated with morbidity and mortality in lower-risk myelodysplastic syndrome (MDS) patients. Many studies have suggested improved survival after iron chelation therapy (ICT), but valid data are limited. The aim of this study was to assess the effect of ICT on overall survival and hematologic improvement in lower-risk MDS patients in the European MDS registry. We compared chelated patients with a contemporary, non-chelated control group within the European MDS registry, that met the eligibility criteria for starting iron chelation. A Cox proportional hazards model was used to assess overall survival (OS), treating receipt of chelation as a time-varying variable. Additionally, chelated and non-chelated patients were compared using a propensity-score matched model. Of 2,200 patients, 224 received iron chelation. The hazard ratio and 95% confidence interval for OS for chelated patients, adjusted for age, sex, comorbidity, performance status, cumulative RBC transfusions, Revised-International Prognostic Scoring System (IPSS-R), and presence of ringed sideroblasts was 0.50 (0.34-0.74). The propensity-score analysis, matched for age, sex, country, RBC transfusion intensity, ferritin level, comorbidity, performance status, and IPSS-R, and, in addition, corrected for cumulative RBC transfusions and presence of ringed sideroblasts, demonstrated a significantly improved OS for chelated patients with a hazard ratio of 0.42 (0.27-0.63) compared to non-chelated patients. Up to 39% of chelated patients reached an erythroid response. In conclusion, our results suggest that iron chelation may improve OS and hematopoiesis in transfused lower-risk MDS patients. This trial was registered at clinicaltrials.gov identifier: 00600860.
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Affiliation(s)
- Marlijn Hoeks
- Centre for Clinical Transfusion Research, Sanquin Research, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ge Yu
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, USA
| | - Saskia Langemeijer
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Simon Crouch
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, USA
| | - Louise de Swart
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Pierre Fenaux
- Service d'Hématologie, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris and Université Paris 7, Paris, France
| | - Argiris Symeonidis
- Department of Medicine, Division of Hematology, University of Patras Medical School, Patras, Greece
| | - Jaroslav Čermák
- Department of Clinical Hematology, Institute of Hematology and Blood Transfusion, Praha, Czech Republic
| | - Eva Hellström-Lindberg
- Department of Medicine, Division of Hematology, Karolinska Institutet, Stockholm, Sweden
| | - Guillermo Sanz
- Department of Haematology, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Reinhard Stauder
- Department of Internal Medicine V (Haematology and Oncology), Innsbruck Medical University, Innsbruck, Austria
| | - Mette Skov Holm
- Department of Haematology, Aarhus University Hospital, Aarhus, Denmark
| | - Moshe Mittelman
- Department of Medicine A, Tel Aviv Sourasky (Ichilov) Medical Center and Sackler Medical Faculty, Tel Aviv University, Tel Aviv, Israel
| | - Krzysztof Mądry
- Department of Haematology, Oncology and Internal Medicine, Warszawa Medical University, Warszawa, Poland
| | - Luca Malcovati
- Department of Hematology Oncology, Fondazione Istituto Di Ricovero e Cura a Carettere Scientifico, Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Aurelia Tatic
- Center of Hematology and Bone Marrow Transplantation, Fundeni Clinical Institute, Bucharest, Romania
| | | | - Ulrich Germing
- Department of Haematology, Oncology and Clinical Immunology, Universitätsklinik Düsseldorf, Düsseldorf, Germany
| | - Aleksandar Savic
- Clinic of Hematology - Clinical Center of Vojvodina, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Njetočka Gredelj Šimec
- Department of Internal Medicine, Division of Hematology, Merkur University Hospital, Zagreb, Croatia
| | - Dominic Culligan
- Department of Haematology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Raphael Itzykson
- Service d'Hématologie, Hôpital Saint-Louis, Assistance Publique des Hôpitaux de Paris and Université Paris 7, Paris, France
| | - Agnes Guerci-Bresler
- Service d'Hématologie, Centre Hospitalier Universitaire Brabois Vandoeuvre, Nancy, France
| | - Borhane Slama
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jackie Droste
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Corine van Marrewijk
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Arjan van de Loosdrecht
- Department of Hematology - Cancer Center Amsterdam VU University Medical Center, Amsterdam, the Netherlands
| | - Nicole Blijlevens
- Department of Hematology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Marian van Kraaij
- Unit Transfusion Medicine, Sanquin Blood Bank, Amsterdam, the Netherlands
| | - David Bowen
- St. James's Institute of Oncology, Leeds Teaching Hospitals, Leeds, UK
| | - Theo de Witte
- Department of Tumor Immunology - Nijmegen Center for Molecular Life Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Alex Smith
- Epidemiology and Cancer Statistics Group, Department of Health Sciences, University of York, York, USA
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11
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de Back DZ, Nezjad SG, Beuger BM, Veldhuis M, Clifford E, Ait Ichou F, Berghuis J, Go M, Gouwerok E, Meinderts S, Vrielink H, de Kort W, de Korte D, van Kraaij M, van Bruggen R. Apheresis causes complement deposition on red blood cells (RBCs) and RBC antigen alterations, possibly inducing enhanced clearance. Transfusion 2018; 58:2627-2634. [PMID: 30265755 DOI: 10.1111/trf.14896] [Citation(s) in RCA: 1] [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] [Received: 02/07/2018] [Revised: 05/28/2018] [Accepted: 05/30/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Apheresis is increasingly being applied to collect cells or plasma, even allowing the collection of multiple blood components during one procedure. Although the quality of the cellular and plasma products that are obtained by apheresis have been extensively studied and shown to be of high quality, the impact of apheresis on the red blood cells (RBCs) that are returned to the donor has not been investigated. STUDY DESIGN AND METHODS The effect of the plasma- or plateletpheresis procedures by four different devices-MCS+ (Haemonetics), PCS2 (Haemonetics), Trima Accel (Terumo BCT), and Autopheresis-C (Auto-C, Fresenius Kabi)-on the RBCs that are returned to the donor was tested in a blinded, prospective trial in a cohort of 25 donors. RESULTS A rheologic analysis of donor RBCs before and after plasma- or plateletpheresis showed no differences in outcome. However, a strong increase in hemolysis was found in samples from the Trima Accel devices after plateletpheresis, compared to all other machines tested. Furthermore, an increase in complement deposition on RBCs was seen after all plasmapheresis procedures (MCS+, PCS2, and Auto-C). Finally, a significant decrease in the expression of the complement-regulating protein CD59 was seen in all postapheresis samples as well as a significant decrease of the adhesion molecule CD147. CONCLUSION The increase in complement deposition and the decrease in the expression of CD59 suggests that RBC clearance might be enhanced after return to the donor. Possible side effects due to an increase in hemolysis after Trima Accel plateletpheresis should be further investigated.
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Affiliation(s)
- Djuna Z de Back
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, the Netherlands.,Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, the Netherlands
| | - Shahryar G Nezjad
- Department of Donor Affairs Sanquin Blood Bank, Sanquin Research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, the Netherlands
| | - Boukje M Beuger
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, the Netherlands
| | - Martijn Veldhuis
- Department of Red Blood Cell Diagnostics, Sanquin Research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, the Netherlands
| | - Els Clifford
- Department of Red Blood Cell Diagnostics, Sanquin Research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, the Netherlands
| | - Fatima Ait Ichou
- Department of Red Blood Cell Diagnostics, Sanquin Research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeffrey Berghuis
- Department of Red Blood Cell Diagnostics, Sanquin Research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, the Netherlands
| | - Mya Go
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, the Netherlands
| | - Eric Gouwerok
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, the Netherlands
| | - Sanne Meinderts
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, the Netherlands
| | - Hans Vrielink
- Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, the Netherlands
| | - Wim de Kort
- Department of Donor Studies, Sanquin Blood Bank, Amsterdam, the Netherlands
| | - Dirk de Korte
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, the Netherlands.,Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, the Netherlands
| | - Marian van Kraaij
- Department of Donor Affairs Sanquin Blood Bank, Sanquin Research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, the Netherlands.,Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, the Netherlands
| | - Robin van Bruggen
- Department of Blood Cell Research, Sanquin Research and Landsteiner Laboratory, University of Amsterdam, Amsterdam, the Netherlands
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12
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Hoeks M, van der Pol M, Middelburg R, Evers D, van Kraaij M, Zwaginga JJ. Bone marrow iron score as an indicator for secondary iron overload in acute myeloid leukemia patients. Eur J Haematol 2018; 101:591-594. [PMID: 30014522 DOI: 10.1111/ejh.13145] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/18/2018] [Accepted: 06/18/2018] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Secondary iron overload due to red blood cell transfusions (RBCT) is associated with increased morbidity and mortality. However, attention for secondary iron overload and its side effects in patients with hematological malignancies may need improvement. The aim of this study was to determine the number of transfused RBCT needed to reach a maximum bone marrow iron score (BMIS). METHODS Bone marrow iron score was independently assessed by two researchers on consecutive bone marrow samples of 35 acute myeloid leukemia (AML) patients. The slides were blinded to both researchers to prevent bias. A Kaplan-Meier survival analysis was performed for estimation of the proportion of patients reaching a maximum BMIS. RESULTS In total, 141 bone marrow specimens from 35 patients were included. The median number of RBCT to reach a maximum was 20 units (range 6-42, IQR 15-26), after a mean of 1.64 chemotherapy courses (SD 0.99). CONCLUSIONS In conclusion, the cumulative RBCT number is associated with BMIS. Due to the considerable variation in number of RBCT to reach a maximum BMIS, BMIS instead of only considering the cumulative RBCT number may be a valuable indicator of secondary iron overload in AML patients. BMIS could guide iron-lowering therapy and/or transfusion strategies in an early stage.
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Affiliation(s)
- Marlijn Hoeks
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Marit van der Pol
- Biomedical sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Rutger Middelburg
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dorothea Evers
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
- Department of Immuno-hematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Marian van Kraaij
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
- Department of Transfusion Medicine, Sanquin Blood Bank, Amsterdam, The Netherlands
- Department of Donor Studies, Sanquin Research, Amsterdam, The Netherlands
| | - Jaap Jan Zwaginga
- Center for Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
- Department of Immuno-hematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
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13
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de Back DZ, Vlaar R, Beuger B, Daal B, Lagerberg J, Vlaar APJ, de Korte D, van Kraaij M, van Bruggen R. A method for red blood cell biotinylation in a closed system. Transfusion 2018; 58:896-904. [PMID: 29446461 DOI: 10.1111/trf.14535] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 02/05/2023]
Abstract
BACKGROUND Several circumstances require the accurate measurement of red blood cell (RBC) survival and clearance, such as determination of posttransfusion recovery of stored RBCs to investigate the effect of new additive solutions. To this end, biotin as a marker of RBCs to track donor RBCs in the blood of the recipient has been used in many studies. However, so far only experimental, nonvalidated, biotin-labeled red cell concentrates (RCCs) are transfused. The goal of this study was to produce a standardized biotin-labeled RCC product in a fast, simple, and sterile manner that can be used for clinical research and for the evaluation of new blood products according to Good Practice Guidelines (GPG) for blood establishments. STUDY DESIGN AND METHODS RCC fractions were labeled with two different concentrations of biotinylation reagent in a closed system, to prevent bacterial contamination of the end product. Using flow cytometry, the reproducibility and robustness of the biotin labeling was assessed, as well as the stability of the biotin label on the (un-)irradiated RCC fraction. Additionally, parameters such as phosphatidylserine (PS) exposure, sodium (Na), potassium (K), free hemoglobin, adenosine triphosphate (ATP), pH, and morphology were determined prior to and after biotin labeling to rule out detrimental effects of the labeling procedure on the RCC. RESULTS Our data show that RCCs can be labeled under sterile conditions in a closed system with two different biotinylation reagent concentrations, without affecting the biological activity. CONCLUSION An easy, rapid (<2 hr), and robust method was developed to manufacture biotin-labeled RCCs for clinical research compliant to GPG.
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Affiliation(s)
- Djuna Z de Back
- Department of Blood Cell Research, Sanquin Research, and Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands
| | - Richard Vlaar
- Department of Blood Cell Research, Sanquin Research, and Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands
| | - Boukje Beuger
- Department of Blood Cell Research, Sanquin Research, and Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands
| | - Brunette Daal
- Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, The Netherlands
| | - Johan Lagerberg
- Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, The Netherlands
| | - Alexander P J Vlaar
- Department of Intensive Care Medicine, Academic Medical Center, Amsterdam, The Netherlands
| | - Dirk de Korte
- Department of Blood Cell Research, Sanquin Research, and Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands.,Department of Product and Process Development, Sanquin Blood Bank, Amsterdam, The Netherlands
| | - Marian van Kraaij
- Departments of Donor Affairs and Transfusion Medicine, Sanquin Blood Bank, Centre of Clinical Transfusion Research, Sanquin Research, Leiden, The Netherlands
| | - Robin van Bruggen
- Department of Blood Cell Research, Sanquin Research, and Landsteiner Laboratory, University of Amsterdam, Amsterdam, The Netherlands
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14
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Rombout-Sestrienkova E, Koek GH, Neslo R, van Kraaij M, Menheere PP, Masclee A, Swinkels DW. Course of iron parameters in HFE-hemochromatosis patients during initial treatment with erythrocytapheresis compared to phlebotomy. J Clin Apher 2016; 31:564-570. [PMID: 26878994 DOI: 10.1002/jca.21451] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [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: 08/21/2015] [Revised: 12/21/2015] [Accepted: 01/25/2016] [Indexed: 12/19/2022]
Abstract
Current treatment for newly diagnosed patients with hereditary hemochromatosis (HH) and iron overload consist of weekly phlebotomy or less frequent and more personalized erythrocytapheresis. Previous observations during phlebotomy suggest an increase in intestinal iron uptake caused by lowering of hepcidin as a result of intensive bloodletting. It is not known whether such an effect is present or even more pronounced using erythrocytapheresis since a larger amount of iron is extracted per procedure. In this study we aimed to assess the effect of erythrocytapheresis on the course of iron parameters, with special focus on serum hepcidin. We performed a retrospective proof-of-principle observational study, comparing serum iron parameters in 12 males during the depletion phase using either phlebotomy (n = 6) or erythrocytapheresis (n = 6). Decreases in serum ferritin over time were similar for both treatments but more pronounced using erythrocytapheresis when expressed per treatment procedure. Hemoglobin did not change during erythrocytapheresis, whereas during phlebotomy decreased with 10%. Increase of erythropoietin and soluble transferrin receptor and decrease in transferrin saturation were similar for both treatments. Reduction in serum hepcidin was higher (50% versus 25% of initial value) and occurred more early using phlebotomy (10 versus 20 weeks after start). In aggregate, compared to phlebotomy, the less frequent and more personalized erythrocytapheresis leads to a more pronounced decrease in serum ferritin per treatment procedure, without a larger decrease in serum hepcidin. This may be clinically relevant and may prevent an increase in intestinal iron uptake and an ensuing vicious circle of more frequent treatment procedures. J. Clin. Apheresis 31:564-570, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Eva Rombout-Sestrienkova
- Blood Bank Division, Department of Transfusion Medicine, Sanquin Blood Supply, Amsterdam, The Netherlands.,Division of Gastroenterology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ger H Koek
- Division of Gastroenterology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rabin Neslo
- Sanquin Blood Supply, University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Transfusion Technology Assessment Department, Utrecht, The Netherlands
| | - Marian van Kraaij
- Blood Bank Division, Department of Transfusion Medicine, Sanquin Blood Supply, Amsterdam, The Netherlands.,Department of Hematology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Paul P Menheere
- Department of Clinical Chemistry, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ad Masclee
- Division of Gastroenterology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dorine W Swinkels
- Department of Laboratory Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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15
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Rombout-Sestrienkova E, Winkens B, Essers BA, Nieman FH, Noord PA, Janssen MC, van Deursen CT, Boonen A, Reuser-Kaasenbrood EP, Heeremans J, van Kraaij M, Masclee A, Koek GH. Erythrocytapheresis versus phlebotomy in the maintenance treatment of HFE hemochromatosis patients: results from a randomized crossover trial. Transfusion 2015; 56:261-70. [DOI: 10.1111/trf.13328] [Citation(s) in RCA: 21] [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: 04/07/2015] [Revised: 07/30/2015] [Accepted: 08/05/2015] [Indexed: 12/11/2022]
Affiliation(s)
- Eva Rombout-Sestrienkova
- Department of Transfusion Medicine; Sanquin Blood Supply; Amsterdam, the Netherlands
- Department of Internal Medicine, Division of Gastroenterology; Maastricht University Medical Centre; Maastricht, the Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistic; School for Public Health and Primary Care (CAPHRI), Maastricht University
| | | | - Fred H.M. Nieman
- Department of Clinical Epidemiology and Medical Technology Assessment
| | | | - Mirian C.H. Janssen
- Department of Internal Medicine; Radboud University Nijmegen Medical Centre; Nijmegen, the Netherlands
| | - Cees Th.B.M. van Deursen
- Department of Internal Medicine; Zuyderland Medical Center; Heerlen/Brunssum/Sittard the Netherlands
| | | | | | - Judith Heeremans
- Department of Transfusion Medicine; Sanquin Blood Supply; Amsterdam, the Netherlands
| | - Marian van Kraaij
- Department of Transfusion Medicine; Sanquin Blood Supply; Amsterdam, the Netherlands
| | - Ad Masclee
- Department of Internal Medicine, Division of Gastroenterology; Maastricht University Medical Centre; Maastricht, the Netherlands
| | - Ger H. Koek
- Department of Internal Medicine, Division of Gastroenterology; Maastricht University Medical Centre; Maastricht, the Netherlands
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16
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de Back DZ, Kostova EB, van Kraaij M, van den Berg TK, van Bruggen R. Of macrophages and red blood cells; a complex love story. Front Physiol 2014; 5:9. [PMID: 24523696 PMCID: PMC3906564 DOI: 10.3389/fphys.2014.00009] [Citation(s) in RCA: 188] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 01/06/2014] [Indexed: 12/13/2022] Open
Abstract
Macrophages tightly control the production and clearance of red blood cells (RBC). During steady state hematopoiesis, approximately 1010 RBC are produced per hour within erythroblastic islands in humans. In these erythroblastic islands, resident bone marrow macrophages provide erythroblasts with interactions that are essential for erythroid development. New evidence suggests that not only under homeostasis but also under stress conditions, macrophages play an important role in promoting erythropoiesis. Once RBC have matured, these cells remain in circulation for about 120 days. At the end of their life span, RBC are cleared by macrophages residing in the spleen and the liver. Current theories about the removal of senescent RBC and the essential role of macrophages will be discussed as well as the role of macrophages in facilitating the removal of damaged cellular content from the RBC. In this review we will provide an overview on the role of macrophages in the regulation of RBC production, maintenance and clearance. In addition, we will discuss the interactions between these two cell types during transfer of immune complexes and pathogens from RBC to macrophages.
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Affiliation(s)
- Djuna Z de Back
- Landsteiner Laboratory, Department of Blood Cell Research, Academic Medical Center, Sanquin Research, University of Amsterdam Amsterdam, Netherlands
| | - Elena B Kostova
- Landsteiner Laboratory, Department of Blood Cell Research, Academic Medical Center, Sanquin Research, University of Amsterdam Amsterdam, Netherlands
| | - Marian van Kraaij
- Landsteiner Laboratory, Department of Blood Cell Research, Academic Medical Center, Sanquin Research, University of Amsterdam Amsterdam, Netherlands
| | - Timo K van den Berg
- Landsteiner Laboratory, Department of Blood Cell Research, Academic Medical Center, Sanquin Research, University of Amsterdam Amsterdam, Netherlands
| | - Robin van Bruggen
- Landsteiner Laboratory, Department of Blood Cell Research, Academic Medical Center, Sanquin Research, University of Amsterdam Amsterdam, Netherlands
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17
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Atsma F, Veldhuizen I, de Kort W, van Kraaij M, Pasker-de Jong P, Deinum J. Hemoglobin level is positively associated with blood pressure in a large cohort of healthy individuals. Hypertension 2012; 60:936-41. [PMID: 22949533 DOI: 10.1161/hypertensionaha.112.193565] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
It has been hypothesized that an increased hemoglobin level elevates blood pressure. The present study investigated the association between hemoglobin level and systolic blood pressure and diastolic blood pressure in healthy persons. The study population was composed of 101 377 whole blood and plasma donors, who made 691 107 visits to the blood bank. At each visit, hemoglobin level and blood pressure were measured as part of the standard procedure before a blood donation. We used repeated measurement analysis to analyze the data. We used generalized estimating equation models to assess the between-person effect and linear mixed models to assess the within-person effect. All of the analyses were done separately for men and women. In the study population, 50% were men. The mean age in men was 49.3 years (±12.5 years), and in women it was 42.4 years (±13.7 years). Hemoglobin level was positively associated with both systolic and diastolic blood pressures. With respect to the between-person effect, regression coefficients for systolic blood pressure were 1.3 mm Hg per millimole per liter increase in hemoglobin level for men and 1.8 mm Hg per millimole per liter increase in hemoglobin level for women. With respect to the within-person effect, regression coefficients for systolic blood pressure were 0.7 mm Hg and 0.9 mm Hg per millimole per liter increase in hemoglobin level, for men and women, respectively. For diastolic blood pressure, results were comparable. The results show that hemoglobin level is positively associated with both systolic and diastolic blood pressures in healthy individuals. We observed consistent effects between persons but also within persons.
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Affiliation(s)
- Femke Atsma
- Sanquin Research, Department of Donor Studies, Geert Grooteplein Zuid 34, PO Box 1013, 6501BA Nijmegen, the Netherlands.
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18
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van Geffen M, Loof A, Lap P, Boezeman J, Laros-van Gorkom BAP, Brons P, Verbruggen B, van Kraaij M, van Heerde WL. A novel hemostasis assay for the simultaneous measurement of coagulation and fibrinolysis. ACTA ACUST UNITED AC 2012; 16:327-36. [PMID: 22183066 DOI: 10.1179/102453311x13085644680348] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Thrombin and plasmin are the key enzymes involved in coagulation and fibrinolysis. A novel hemostasis assay (NHA) was developed to measure thrombin and plasmin generation in a single well by a fluorimeter. The NHA uses two fluorescent substrates with non-interfering fluorescent excitation and emission spectra. The assay was tested in vitro using modulators like heparin, hirudin, epsilon-aminocaproic acid, gly-pro-arg-pro peptide and reptilase and validated by measurement of prothrombin fragment 1+2 and plasmin-alpha2-antiplasmin levels. Intra- and inter-assay coefficients of variation were < 9% and 6-25%, respectively. Interplay between coagulation and fibrinolysis was demonstrated by the effect of tissue-type plasminogen activator on thrombin generation and by the different responses of activated protein C and thrombomodulin on fibrinolysis. The last responses showed the linkage between coagulation and fibrinolysis by thrombin activatable fibrinolysis inhibitor. In conclusion, this strategy allows detection of coagulation, fibrinolysis and their interplay in a single assay.
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Affiliation(s)
- Mark van Geffen
- Laboratory of Hematology, Department of Laboratory Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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