Impact of the COVID-19 outbreak on blood supply in two large university hospitals.

OBJECTIVE: This study aimed to examine the relationship between the decrease in elective procedures and the need for blood donation during the novel coronavirus disease (COVID-19) pandemic at university hospitals. BACKGROUND: The COVID-19 pandemic has immensely impacted transfusion medicine. By cancelling elective surgery, the German government hoped to increase the available resources for patients infected with COVID-19, especially in intensive care units, and prevent the shortage of blood products. METHODS/MATERIALS: Over 26 weeks, from the 3rd of February 2020 to the 2nd of August 2020, during the first phase of the pandemic, we assessed the number of crossmatches, blood group typing, use of donated blood, and case mix indices by retrospectively analysing data from two major university hospitals' information systems in Essen and Hamburg, Germany. Data were pooled, analysed, and compared with that of the same period in the previous year. RESULTS: Following the cessation of elective procedures, the number of requests for crossmatches and blood group typing significantly decreased in 2020 compared to that in 2019. However, the number of blood transfusions required was reduced to a lesser extent. The number of outpatient and inpatient cases significantly decreased, whereas the cases requiring transfusion decreased only. CONCLUSION: During the initial phase of the pandemic, transfusion medicine, especially in large institutions, faced an almost unchanged high demand for donated blood. This should be considered regarding personnel and blood donation allocations. Therefore, we developed a monitoring system to display the availability of blood products in real-time. The quick and easy display of in-stock and expiring blood products can optimise the use of this valuable resource.

Galactomannan and PCR in the Central Nervous System to Detect Invasive Mold Disease - A Retrospective Analysis in Immunocompromised Children.

Invasive mold disease (IMD) of the central nervous system (CNS) is a severe infectious complication in immunocompromised patients, but early microbiological diagnosis is difficult. As data on the value of biomarkers in the CNS are scarce, in particular in children, we retrospectively analyzed the performance of galactomannan (GM) and PCR assays in CNS samples of 15 children with proven and probable CNS IMD and of 32 immunocompromised children without fungal infection. Galactomannan in the cerebrospinal fluid (CSF) was assessed in nine of the 15 pediatric patients and was positive in five of them. Polymerase chain reaction (PCR) was performed in eight of the 15 patients and detected nucleic acids from molds in six patients. Galactomannan and PCR in CNS samples were the only positive microbiologic parameter in the CNS in three and two patients, respectively. In four patients, PCR specified the pathogen detected in microscopy. Galactomannan and PCR results remained negative in the CSF of all immunocompromised children without evidence for CNS IMD. Our data suggest that GM and PCR in CNS specimens are valuable additional tools in diagnosing CNS IMD and should be included in the work up of all pediatric patients with suspected mold disease of the CNS.

Invasive mold disease of the central nervous system in children and adolescents with cancer or undergoing hematopoietic stem cell transplantation: Analysis of 29 contemporary patients.

BACKGROUND: Invasive mold disease (IMD) is a severe infectious complication in immunocompromised patients. The outcome of central nervous system (CNS) IMD is poor, but contemporary data, in particular in the pediatric setting, are lacking. PROCEDURE: For this retrospective multicenter analysis, pediatric patients < 18 years with proven or probable CNS IMD receiving chemotherapy or undergoing allogeneic HSCT were reported by the local investigator. CNS IMD had to be diagnosed between 2007 and 2016. Proven CNS IMD was defined as compatible CNS imaging or macroscopic autopsy findings in conjunction with a positive microscopic or microbiological result in the brain tissue or cerebrospinal fluid. Probable CNS IMD was defined as compatible CNS imaging findings in combination with proven or probable IMD at a site outside the CNS. RESULTS AND CONCLUSIONS: A total of 29 patients (median age, 14 years; 14 allogeneic HSCT recipients) were diagnosed with proven (n = 12) or probable (n = 17) CNS IMD. Aspergillus spp. was the most common fungal pathogen. All but one patient had IMD sites outside the CNS and eight patients (27.6%) were neurologically asymptomatic at diagnosis of CNS IMD. Forty-nine percent of the patients survived CNS IMD; however, 46.7% of the survivors suffered from severe long-term neurological sequelae. Our data suggest that (1) outcome of CNS IMD has improved in children as compared with previous series, (2) half of surviving patients suffer from severe neurological sequelae, and (3) imaging of the CNS should be performed in all children with IMD irrespective of neurological symptoms.

[Recommendations for Diagnostics and Therapy of Children with Cancer Presenting with Fever and Neutropenia - Comparison of Two Current Guidelines]. / Empfehlungen zur Diagnostik und Therapie bei krebskranken Kindern mit Fieber und Neutropenie ­ Vergleich zweier aktueller Leitlinien.

Immunocompromised children and adolescents receiving treatment for cancer have a considerably increased risk for infection. Neutropenia is the most important single risk factor for infectious complications, and fever in neutropenia is considered as an emergency. Whereas guidelines for the management of fever in neutropenic adults have been established for decades, specific pediatric guidelines have not been developed until recently. As children differ in many aspects from adults such as in the underlying malignancy or in the availability and dosing of antimicrobial compounds, guidelines for pediatric patients are important. This article reviews similarities and differences between the recently published German interdisciplinary guideline of the German Societies of Pediatric Infectious Diseases and Pediatric Oncology and Hematology and a guideline developed by a panel of international experts for the management of fever in neutropenia in children and adolescents.

Organochlorine pesticides and PAHs in the surface water and atmosphere of the North Atlantic and Arctic Ocean.

Surface seawater and boundary layer atmospheric samples were collected on the FS Polarstern during cruise ARKXX in the North Atlantic and Arctic Ocean in 2004. Samples were analyzed for persistent organic pollutants (POPs), with a focus on organochlorine pesticides, including hexachlorocyclohexanes (HCHs), chlordanes, DDTs, hexachlorobenzene (HCB), and polycyclic aromatic hydrocarbons. In addition, the enantiomer fractions (EFs) of pesticides, notably alpha-HCH and cis-chlordane (CC), were determined. Concentrations of dissolved HCB increased from near Europe (approximately 1-2 pg/L) toward the high Arctic (4-10 pg/L). For dissolved HCB, strongest correlations were obtained with the average air or water temperature during sampling, not latitude. In the western Arctic Ocean, surface waters with elevated concentrations of HCB (5-10 pg/ L) were flowing out of the Arctic Ocean as part of the East Greenland current In contrast to dissolved compounds, atmospheric POPs did not display trends with temperature. Air-water exchange gradients suggested net deposition for all compounds, though HCB was closest to air-water equilibrium. EFs for alpha-HCH in seawater ranged from 0.43 to 0.50, except for two samples from 75 degrees N in the East Greenland Sea, with EFs of 0.31 and 0.37. Lowest EF (0.47) for CC were also at 75 degrees N, other samples had EFs from 0.49 to 0.52. It is suggested that samples from around 75 degrees N in the Greenland Gyre represented a combination of surface and older/deeper Arctic water.

Optimized method avoiding solvent-induced response enhancement in the analysis of volatile and semi-volatile polyfluorinated alkylated compounds using gas chromatography-mass spectrometry.

A method for the analysis of airborne (semi-)volatile polyfluorinated alkyl substances (PFASs) was optimized to avoid solvent-induced response enhancements as observed using ethyl acetate as extraction solvent (recoveries up to 300%, likely due to acetic acid as impurity). Of nine solvents tested, only the use of acetone, dichloromethane, methyl tert-butyl ether, and acetone:petroleum ether (1:1, v/v) resulted in recoveries below 100% and acetone:methyl tert-butyl ether (1:1, v/v) was chosen as suited extraction solvent. An appropriate GC capillary column and the application of mass-labelled internal standards appeared to be essential for these analyses. Instrumental limits of detection of <0.2 pg (dimethylperfluoroocatanesulfonamide, ethyl-[(2)H(5)]perfluorooctanesulfonamide, methyl-[(2)H(3)]perfluorooctanesulfonamide) to 8.2 pg (perfluorooctanesulfonamide) and LOQ of 0.4 pg (dimethylperfluoroocatanesulfonamide, ethyl-[(2)H(5)]perfluorooctanesulfonamide, methyl-[(2)H(3)]perfluorooctanesulfonamide) to 16.4 pg (perfluorooctanesulfonamide) were determined.