Development and validation of a scoring system to predict vasovagal reaction upon whole-blood donation.

BACKGROUND AND OBJECTIVES: Risk factors for vasovagal reaction (VVR) have been extensively studied. With knowledge of the relative importance of these risk factors for VVR, collection staff could take care of blood donors from the same standpoint, leading to improved donor safety. We therefore developed a scoring system to predict VVR, which incorporates registration information. MATERIALS AND METHODS: Pre-syncopal and syncopal symptoms, as well as on- and off-site reactions, are included in this analysis as VVR. We defined the donor status as follows: first-time donors, repeat donors with no history of reaction and repeat donors with a history of reaction. We prepared two datasets: whole-blood donations at a blood donation site in Tokyo between January 2019 and December 2019 were included in training data (n = 361,114), and whole-blood donations between January 2020 and August 2020 were included in testing data (n = 216,211). RESULTS: The most important variable was the donor status, followed by age, estimated blood volume and height. We integrated them into a scoring system. Training and testing datasets were combined (n = 577,325), and VVR rates in groups with scores of 0, 1, 2, 3, 4 and 5 or more were 0.09% (95% CI: 0.081%-0.10%), 0.33% (95% CI: 0.31%-0.36%), 0.87% (95% CI: 0.78%-0.96%), 1.17% (95% CI: 1.05%-1.30%), 2.15% (95% CI: 1.98%-2.32%) and 3.11% (95% CI: 2.90%-3.34%), respectively. CONCLUSION: The scoring system enables staff to significantly predict VVR and may help them to identify donors at increased risk of experiencing syncope, thereby mitigating the negative impact of VVR on donor safety and return by paying close attention to high-risk donors.

Syncopal-type reactions tend to be delayed and result in falls among elderly blood donors.

BACKGROUND: Delayed syncopal-type complications are infrequent among blood donors, but sometimes have critical consequences, such as severe injury. We retrospectively investigated the characteristics of donors with delayed syncopal-type complications or falls. STUDY DESIGN AND METHODS: We defined a delayed reaction (DR) as syncopal-type complications occurring >20 min after needle removal. Subjects were stratified by sex, age, estimated blood volume (EBV), body mass index (BMI) and frequency of donation. Multiple logistic regression analysis and propensity score weighted M estimation were performed to evaluate the covariate-adjusted risk of syncopal DRs among donors giving 400 ml of whole blood (WB). The DR rate was calculated as the number of DRs divided by the number of all syncopal-type reactions after needle removal. The risk of falls was assessed similarly. Donors who discontinued before completing phlebotomy (donation of 400 ml) were excluded. RESULTS: Among 3818 syncopal-type reactions after needle removal, there were 359 DRs and 93 falls. Elderly donors and female donors with syncopal-type reactions had a significantly higher risk of DRs (P for trend < 0·001). Elderly donors with syncopal-type reactions also had a higher risk of falls (P for trend < 0·001). Among all donors with syncopal-type reactions, the risk of DRs or falls was not correlated with EBV, BMI or donation frequency. CONCLUSION: In female donors and elderly donors (donating 400 ml of WB), syncopal-type reactions tended to be delayed. Elderly donors with syncopal-type reactions had a significantly higher risk of falls.

Association between metallothionein genes polymorphisms and sporadic amyotrophic lateral sclerosis in a Japanese population.

Amyotrophic lateral sclerosis (ALS) is a progressive, lethal neurodegenerative disease that selectively affects motor neurons. Reactive oxygen species (ROS) are assumed to be involved in the pathogenesis of ALS. Metallothioneins (MTs) are self-protective, multifunctional proteins that scavenge ROS. In particular, metallothionein-III (MT-III) has a strong scavenging effect on hydroxyl radicals. MTs have been suggested to have important roles in the pathophysiology of ALS. Therefore we investigated single nucleotide polymorphisms (SNPs) of the MT-III and the metallothionein-IIA (MT-IIA) promoter region in 37 Japanese SALS cases and 206 sex-matched healthy controls using polymerase chain reaction (PCR)-direct sequencing or PCR-temporal temperature gradient gel electrophoresis (TTGE). We detected no SNPs of the MT-III gene in SALS cases and controls, and no detectable association between SALS phenotypes and a SNP of the MT-IIA promoter region. We conclude that gene polymorphisms of MT-IIA promoter region and MT-III gene are not associated with SALS phenotypes in a Japanese population.

[A case of non-herpetic acute encephalitis with autoantibodies for ionotropic glutamate receptor delta2 and epsilon2].

We report a 45-year-old woman admitted to our hospital due to fever, consciousness disturbance, and severe seizures. Based on her signs and symptoms and clinical course, a diagnosis of non-herpetic acute encephalitis was made. She received antibiotic drugs, acyclovir, gamma-globulin, and steroid pulse therapy (methylprednisolone 1 g/day, 3 days). The patient's signs, symptoms and severe seizure showed marked improvement, but she still showed monthly seizure attacks and both anterograde and retrograde amnesia Viral infection and autoimmune response after viral infection may have been involved in non-herpetic acute encephalitis in our patient. Recently, autoantibodies to GluRepsilon2 and VGKC were reported in cases of non-herpetic acute limbic encephalitis (NHALE). In our patient, we detected IgM type autoantibody to GluRdelta2 and epsilon2 in both the CSF and serum, and these antibodies normalized in the CSF with the clinical course. Autoantibodies to GluRdelta2 and epsilon2 may be involved in the clinical symptoms and pathogenesis of non herpetic acute limbic encephalitis. This is the first report of MRI-positive non-herpetic acute encephalitis with autoantibodies to GluRdelta2 and epsilon2.

[A case of meningeal carcinomatosis due to the ethmoid sinus mucoepidermoid carcinoma].

We report here a 65-year-old man with ptosis, diplopia, and progressive lower limb muscle weakness without nasal symptoms. CA19-9 and CEA were elevated in the serum and cerebrospinal fluid (CSF), but Squamous Cell Carcinoma Antigen (SCC) was not. CA19-9-positive atypical cells were found in the CSF. A right ethmoidal tumor was discovered by paranasal CT and 18F-Deoxyglucose Positron Emission Tomography (FDG-PET) studies. The ethmoidal tumor invaded to the orbits and disseminated into the CSF space through the cribriform plate. Biopsy demonstrated that the paranasal tumor consisted of mucoepidermoid carcinoma. We report here the first case of meningeal carcinomatosis due to mucoepidermoid carcinoma in the ethmoid sinus.

[Diagnosis of adult type of Niemann-Pick disease (type C) in two brothers by filipin staining of bone marrow smears].

Niemann-Pick disease, type C (NPC) is a neurometabolic genetic disorder that is distinguished from other types of Niemann-Pick disease by its later onset, more insidious progression, variable visceromegaly, and abnormalities of intracellular cholesterol metabolism. We report cases in 18-year-old and 20-year-old brothers who presented with disinhibition and involuntary movement of their hands. Both brothers presented various signs such as dementia, vertical supranuclear ophthalmoplegia (VSO), dysarthria, axial and limb dystonia, hyperreflexia, pathologic reflex, cerebellar ataxia, as reported. They also presented startle response. Brain MRI showed diffuse cerebral atrophy and abdominal CT reveals hepato-splenomegaly in both patients. These cases were suspected to be NPC based on dementia, VSO, cerebellar ataxia, hepato-splenomegaly and foam cells in the bone marrow. Generally, the diagnosis of NPC is based on deficient cholesterol esterification and excessive lysosomal filipin staining in cultured skin fibroblasts. However, culture of fibroblasts obtained from a biopsied skin samples is slow. We have rapidly made the diagnosis of NPC in our patients by filipin staining of foam cells from bone marrow. This diagnostic process using a bone marrow smear is more convenient and rapid than previous methods using cultured skin fibroblasts.