Optimization of the management of platelet concentrate stocks in the Basque Country using mathematical simulation.

BACKGROUND AND OBJECTIVES: The management of platelet concentrate (PC) stocks is not simple given their short shelf life and variable demand. In general, managers decide on PC production based on personal experience. The objective of this study was to provide a tool to help decide how many PC units to produce each day in a more rational and objective way. MATERIALS AND METHODS: From the historical data on PCs produced, transfused and discarded in the Basque Country in 2012, a mathematical model was built, based on the normality of the time series of the transfusions performed on each day of the week throughout the year. This model was implemented in an easy-to-use Excel spreadsheet and validated using real production data from 2013. RESULTS: Comparing with real 2013 data, in the best scenario, the number of PC units that expired was 87·7% lower, PC production, 14·3% lower and the age of the PCs transfused nearly 1-day younger in the simulation. If we want to ensure a minimum stock at the end of each day, the outdating rate and average age of the transfused PCs progressively increase. CONCLUSION: The practical application of the designed tool can facilitate decision-making about how many PC units to produce each day, resulting in very significant reductions in PC production and wastage and corresponding cost savings, together with an almost 1 day decrease in the mean age of PCs transfused.

[Frequency of selective IgA deficiency in Basque Country]. / Frecuencia del déficit selectivo de IgA en el País Vasco.

BACKGROUND: To evaluate the frequency of IgA deficiency in the Basque Country, Spain, and establish a file of IgA-deficient blood donors, using a self laboratory test and checking medical records. MATERIALS AND METHODS: A screening radial immunodiffusion system was used on 2.607 blood donors samples. A search on the patients laboratory results was realized. RESULTS: Five blood donors were detected, and 2 of 30 patients fulfilled criteria for donation. CONCLUSIONS: The frequency obtained of IgA deficiency in the Basque Country was 1/521. The used method is economical and optimum to create a file of IgA-deficient blood donors.

[The impact of the implementation of staying in the United Kingdom for six months or more as donor exclusion criteria on the donor base of the Basque Country]. / Repercusión de la implantación de la estancia en el Reino Unido durante seis o más meses como motivo de exclusión sobre la base de donantes de sangre en el País Vasco.

BACKGROUND: To reduce the risk of new variant Creutzfeldt-Jakob disease by blood products some countries exclude persons who have spent six months or more cumulatively in the United Kingdom as blood donors. METHOD: We asked our donors about this selection criteria to evaluate the loss of blood donors and donations in case of implementation of this measure. RESULTS: 11,681 donors and 1,648 refused persons were analyzed. 123 (1.05%) and 11 (0.66%) respectively fulfilled this criteria. CONCLUSIONS: In case of implementation of this selection criteria 1% of blood donors and 1.77% blood donations would be lost.

[Pure red-cell aplasia associated with chronic myeloproliferative syndromes]. / Aplasia pura de serie roja asociada a síndromes mieloproliferativos crónicos.

Pure red cell aplasia is manifested by unregenerative anemia with intense erythroid hypoplasia in the bone marrow and absolute reticulocytopenia. Its association with chronic myeloproliferative syndrome (CMS) is infrequent. The appearance of both processes may or may not be simultaneous and accidental association cannot be ruled out. Two cases of pure red cell aplasia were studied; one associated to Philadelphia positive chronic chromosome myeloid leukemia and the other associated to atypical CMS. In the first case no response was obtained with prednisone alone or associated to cyclophosphamide. In the second patient treatment with danazol was not efficient, however, corticotherapy produced a positive and maintained response. Treatment of pure red cell aplasia associated to CMS must be the same as that employed when this disease is presented as isolated or associated to other processes.

Non-secretory multiple myeloma presenting as primary plasma cell leukaemia.

A case of non-secretory multiple myeloma presenting as primary plasma cell leukaemia in a 65 year old woman is presented. Bone pain was the initial clinical manifestation. Laboratory analysis showed 20% of circulating immature plasma cells. Despite the presence of osteolytic lesions, no M-component could be demonstrated in serum protein electrophoresis, and serum and urine immunoelectrophoresis. Bone marrow aspirate demonstrated an 83% infiltration of plasma cells showing various degrees of immaturity. Immunofluorescence with monoclonal antisera demonstrated intracytoplasmic kappa light chains in a high percentage of plasma cells. Immature plasma cells without cellular capacity to synthesize and excrete complete immunoglobulins could be more aggressive, leading to an initial leukaemic process. Previous work regarding possible pathogenetic mechanisms, clinical and laboratory features, and response to treatment of this extremely rare association are reviewed.

Quinidine-induced agranulocytosis of abrupt onset.

Drug-induced agranulocytosis is a clinical entity characterized by a selective reduction of circulating neutrophils, usually to a level less than 0.2 x 10(9)/l in relation to the administration of the drug. Quinidine is an antiarrhythmic agent widely used on an outpatient basis with some well-known hematological side effects. Its midterm administration has been related to a few cases of agranulocytosis. Herein, we describe the case of a 60-year-old man with atrial fibrillation who presented quinidine-induced agranulocytosis of abrupt onset only 3 days after the exposure to the drug, recovering normal levels of neutrophils during the 3rd hospitalization day. Pathogenic mechanisms are discussed.