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1.
Int J Mol Sci ; 22(14)2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34298882

RESUMO

Platelets can modulate cancer through budding of platelet microparticles (PMPs) that can transfer a plethora of bioactive molecules to cancer cells upon internalization. In acute myelogenous leukemia (AML) this can induce chemoresistance, partially through a decrease in cell activity. Here we investigated if the internalization of PMPs protected the monocytic AML cell line, THP-1, from apoptosis by decreasing the initial cellular damage inflicted by treatment with daunorubicin, or via direct modulation of the apoptotic response. We examined whether PMPs could protect against apoptosis after treatment with a selection of inducers, primarily associated with either the intrinsic or the extrinsic apoptotic pathway, and protection was restricted to the agents targeting intrinsic apoptosis. Furthermore, levels of daunorubicin-induced DNA damage, assessed by measuring gH2AX, were reduced in both 2N and 4N cells after PMP co-incubation. Measuring different BCL2-family proteins before and after treatment with daunorubicin revealed that PMPs downregulated the pro-apoptotic PUMA protein. Thus, our findings indicated that PMPs may protect AML cells against apoptosis by reducing DNA damage both dependent and independent of cell cycle phase, and via direct modulation of the intrinsic apoptotic pathway by downregulating PUMA. These findings further support the clinical relevance of platelets and PMPs in AML.


Assuntos
Apoptose/fisiologia , Micropartículas Derivadas de Células/fisiologia , Dano ao DNA/efeitos dos fármacos , Dano ao DNA/fisiologia , Daunorrubicina/farmacologia , Células THP-1/fisiologia , Apoptose/efeitos dos fármacos , Plaquetas , Micropartículas Derivadas de Células/efeitos dos fármacos , Micropartículas Derivadas de Células/metabolismo , Células Cultivadas , Regulação para Baixo/efeitos dos fármacos , Regulação para Baixo/fisiologia , Humanos , Leucemia Mieloide Aguda/tratamento farmacológico , Leucemia Mieloide Aguda/metabolismo , Leucemia Mieloide Aguda/patologia , Proteínas Proto-Oncogênicas c-bcl-2/metabolismo , Transdução de Sinais/efeitos dos fármacos , Transdução de Sinais/fisiologia , Células THP-1/efeitos dos fármacos , Células THP-1/metabolismo
2.
Transfusion ; 61 Suppl 1: S22-S31, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34269432

RESUMO

BACKGROUND: Civilian and military guidelines recommend early balanced transfusion to patients with life-threatening bleeding. Low titer group O whole blood was introduced as the primary blood product for resuscitation of massive hemorrhage at Haukeland University Hospital, Bergen, Norway, in December 2017. In this report, we describe the whole blood program and present results from the first years of routine use. STUDY DESIGN AND METHODS: Patients who received whole blood from December 2017 to April 2020 were included in our quality registry for massive transfusions. Post-transfusion blood samples were collected to analyze isohemagglutinin (anti-A/-B) and hemolysis markers. Administration of other blood products, transfusion reactions, and patient survival (days 1 and 30) were recorded. User experiences were surveyed for both clinical and laboratory staff. RESULTS: Two hundred and five patients (64% male and 36% female) received 836 units in 226 transfusion episodes. Patients received a mean of 3.7 units (range 1-35) in each transfusion episode. The main indications for transfusion were trauma (26%), gastrointestinal (22%), cardiothoracic/vascular (18%), surgical (18%), obstetric (11%), and medical (5%) bleeding. There was no difference in survival between patients with blood type O when compared with non-group O. Haptoglobin level was lower in the transfusion episodes for non-O group patients, however no clinical hemolysis was reported. No patients had conclusive transfusion-associated adverse events. Both clinical and laboratory staff preferred whole blood to component therapy for massive transfusion. DISCUSSION: The experience from Haukeland University Hospital indicates that whole blood is feasible, safe, and effective for in-hospital treatment of bleeding.


Assuntos
Transfusão de Sangue , Ressuscitação , Reação Transfusional/etiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/métodos , Criança , Pré-Escolar , Feminino , Hemólise , Hospitais , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Noruega/epidemiologia , Ressuscitação/métodos , Reação Transfusional/sangue , Reação Transfusional/patologia , Adulto Jovem
3.
Transfusion ; 61 Suppl 1: S80-S89, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34269444

RESUMO

BACKGROUND: Collection of non-leukoreduced citrate-phosphate-dextrose-adenine (CPDA-1) whole blood is performed in walking blood banks. Blood collected under field conditions may have increased risk of bacterial contamination. This study was conducted to examine the effects of WBC reduction and storage temperature on growth of Escherichia coli (ATCC® 25922™) in CPDA-1 whole blood. METHODS: CPDA-1 whole blood of 450 ml from 10 group O donors was inoculated with E. coli. Two hours after inoculation, the test bags were leukoreduced with a platelet-sparing filter. The control bags remained unfiltered. Each whole blood bag was then split into three smaller bags for further storage at 2-6°C, 20-24°C, or 33-37°C. Bacterial growth was quantified immediately, 2 and 3 h after inoculation, on days 1, 3, 7, and 14 for all storage temperatures, and on days 21 and 35 for storage at 2-6°C. RESULTS: Whole blood was inoculated with a median of 19.5 (range 12.0-32.0) colony-forming units per ml (CFU/ml) E. coli. After leukoreduction, a median of 3.3 CFU/ml (range 0.0-33.3) E. coli remained. In the control arm, the WBCs phagocytized E. coli within 24 h at 20-24°C and 33-37°C in 9 of 10 bags. During storage at 2-6°C, a slow self-sterilization occurred over time with and without leukoreduction. CONCLUSIONS: Storage at 20-24°C and 33-37°C for up to 24 h before leukoreduction reduces the risk of E. coli-contamination in CPDA-1 whole blood. Subsequent storage at 2-6°C will further reduce the growth of E. coli.


Assuntos
Preservação de Sangue , Segurança do Sangue , Infecções por Escherichia coli/microbiologia , Escherichia coli/crescimento & desenvolvimento , Procedimentos de Redução de Leucócitos , Adenina/química , Preservação de Sangue/métodos , Citratos/química , Escherichia coli/isolamento & purificação , Glucose/química , Humanos , Temperatura
4.
Transfusion ; 61 Suppl 1: S101-S110, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34269459

RESUMO

BACKGROUND: There is a global increase in whole blood usage and at the same time, emerging pathogens give cause for pathogen reduction technology (PRT). The Mirasol PRT has shown promising results for plasma and platelet concentrate products. Treatment of whole blood with subsequent platelet survival and recovery analysis would be of global value. STUDY DESIGN AND METHODS: A two-arm, open-label laboratory study was performed with 40 whole blood collections in four groups: non-leukoreduced non-PRT-treated, non-leukoreduced PRT-treated, leukoreduced non-PRT-treated, and leukoreduced PRT-treated. Leukoreduction and/or PRT-treatment was performed on the day of collection, then all WB units were stored at room temperature for 24 h. Sampling was performed after hold-time and after 24-h storage in RT. If PRT-treatment or leukoreduction, samples were also taken subsequently after treatment. Thirteen healthy volunteer blood donors completed the in vivo study per protocol. All WB units were non-leukoreduced and PRT-treated. Radioactive labeling of platelets from RT-stored, PRT-treated whole blood, sampling of subjects, recovery, and survival calculations were performed according to the Biomedical Excellence for Safer Transfusion Collaborative protocol. RESULTS: In vitro characteristics show that PRT-treatment leads to increased levels of hemolysis, potassium, and lactate, while there are decreased levels of glucose, FVIII, and fibrinogen after 24 h of storage. All values are within requirements for WB. In vivo recovery and survival of platelets were 85.4% and 81.3% of untreated fresh control, respectively. CONCLUSIONS: PRT-treatment moderately reduces whole blood quality but is well within the limits of international guidelines. Recovery and survival of platelets are satisfactory after Mirasol treatment.


Assuntos
Plaquetas/efeitos dos fármacos , Plaquetas/efeitos da radiação , Segurança do Sangue , Fármacos Fotossensibilizantes/farmacologia , Riboflavina/farmacologia , Raios Ultravioleta , Plaquetas/citologia , Preservação de Sangue , Humanos , Testes de Função Plaquetária , Fatores de Tempo
5.
Cancers (Basel) ; 13(8)2021 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-33919720

RESUMO

The role of platelets in cancer development and progression is increasingly evident, and several platelet-cancer interactions have been discovered, including the uptake of platelet microparticles (PMPs) by cancer cells. PMPs inherit a myriad of proteins and small RNAs from the parental platelets, which in turn can be transferred to cancer cells following internalization. However, the exact effect this may have in acute myelogenous leukemia (AML) is unknown. In this study, we sought to investigate whether PMPs could transfer their contents to the THP-1 cell line and if this could change the biological behavior of the recipient cells. Using acridine orange stained PMPs, we demonstrated that PMPs were internalized by THP-1 cells, which resulted in increased levels of miR-125a, miR-125b, and miR-199. In addition, co-incubation with PMPs protected THP-1 and primary AML cells against daunorubicin-induced cell death. We also showed that PMPs impaired cell growth, partially inhibited cell cycle progression, decreased mitochondrial membrane potential, and induced differentiation toward macrophages in THP-1 cells. Our results suggest that this altering of cell phenotype, in combination with decrease in cell activity may offer resistance to daunorubicin-induced apoptosis, as serum starvation also yielded a lower frequency of dead and apoptotic cells when treated with daunorubicin.

6.
Case Rep Crit Care ; 2021: 6676407, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33763260

RESUMO

Spontaneous splenic rupture is a life-threatening condition leading to a rapidly progressing hypovolemic shock due to intra-abdominal blood loss, with a mortality rate of about 10%. Spontaneous splenic rupture can be caused by widely different disorders including acute and chronic infections, neoplastic disorders, and inflammatory noninfectious disorders. In this case report, we present a 67-year-old male patient with hemorrhagic shock caused by an acute bleeding from the splenic artery. The patient was massively transfused with blood products and fluids and underwent laparotomy for hemostatic control and clinical stabilization. Multiorgan involvement by amyloid light-chain amyloidosis (AL-amyloidosis) caused by plasma cell dyscrasia, specifically with infiltration of the spleen artery, was found to be the underlying cause of his life-threatening bleeding. Based on this case, we discuss the features of serious spleen bleeding, massive transfusion therapy in the intensive care setting, and AL-amyloidosis pathophysiology and treatment.

7.
Vox Sang ; 116(2): 167-174, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32996604

RESUMO

Whole blood is the original blood preparation but disappeared from the blood bank inventories in the 1980s following the advent of component therapy. In the early 2000s, both military and civilian practice called for changes in the transfusion support for massive haemorrhage. The 'clear fluid' policy was abandoned and replaced by early balanced transfusion of platelets, plasma and red cells. Whole blood is an attractive alternative to multi-component therapy, which offers reduced hemodilution, lower donor exposure and simplified logistics. However, the potential for wider re-introduction of whole blood requires re-evaluation of haemolysins, storage conditions and shelf-life, the need for leucocyte depletion/ pathogen reduction and inventory management for blood providers. This review addresses these questions and calls for research to define the optimal whole blood product and the indications for its use.


Assuntos
Transfusão de Sangue , Humanos
8.
Stem Cell Res Ther ; 11(1): 351, 2020 09 23.
Artigo em Inglês | MEDLINE | ID: mdl-32962723

RESUMO

BACKGROUND: Human platelet lysate (HPL) is emerging as the preferred xeno-free supplement for the expansion of mesenchymal stromal cells (MSCs) for bone tissue engineering (BTE) applications. Due to a growing demand, the need for standardization and scaling-up of HPL has been highlighted. However, the optimal storage time of the source material, i.e., outdated platelet concentrates (PCs), remains to be determined. The present study aimed to determine the optimal storage time of PCs in terms of the cytokine content and biological efficacy of HPL. METHODS: Donor-matched bone marrow (BMSCs) and adipose-derived MSCs (ASCs) expanded in HPL or fetal bovine serum (FBS) were characterized based on in vitro proliferation, immunophenotype, and multi-lineage differentiation. Osteogenic differentiation was assessed at early (gene expression), intermediate [alkaline phosphatase (ALP) activity], and terminal stages (mineralization). Using a multiplex immunoassay, the cytokine contents of HPLs produced from PCs stored for 1-9 months were screened and a preliminary threshold of 4 months was identified. Next, HPLs were produced from PCs stored for controlled durations of 0, 1, 2, 3, and 4 months, and their efficacy was compared in terms of cytokine content and BMSCs' proliferation and osteogenic differentiation. RESULTS: BMSCs and ASCs in both HPL and FBS demonstrated a characteristic immunophenotype and multi-lineage differentiation; osteogenic differentiation of BMSCs and ASCs was significantly enhanced in HPL vs. FBS. Multiplex network analysis of HPL revealed several interacting growth factors, chemokines, and inflammatory cytokines. Notably, stem cell growth factor (SCGF) was detected in high concentrations. A majority of cytokines were elevated in HPLs produced from PCs stored for ≤ 4 months vs. > 4 months. However, no further differences in PC storage times between 0 and 4 months were identified in terms of HPLs' cytokine content or their effects on the proliferation, ALP activity, and mineralization of BMSCs from multiple donors. CONCLUSIONS: MSCs expanded in HPL demonstrate enhanced osteogenic differentiation, albeit with considerable donor variation. HPLs produced from outdated PCs stored for up to 4 months efficiently supported the proliferation and osteogenic differentiation of MSCs. These findings may facilitate the standardization and scaling-up of HPL from outdated PCs for BTE applications.


Assuntos
Plaquetas , Células-Tronco Mesenquimais , Osteogênese , Engenharia Tecidual , Técnicas de Cultura de Células , Diferenciação Celular , Proliferação de Células , Células Cultivadas , Humanos , Manejo de Espécimes , Fatores de Tempo
9.
Transfusion ; 60(12): 2793-2800, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32918285

RESUMO

Civilian and military guidelines recommend balanced transfusion to patients with life-threatening bleeding. Early start of transfusion has shown improved survival. Thus, a balanced blood inventory must be available in all levels of health care to ensure early stabilization and damage control resuscitation of patients with bleeding. Whole blood has been reintroduced as a blood product for massive bleeding situations because it affords plasma, red blood cells, and platelets in a balanced ratio in a logistically advantageous way. In this article, we describe how to establish a whole blood-based blood preparedness program in a small rural hospital with limited resources. We present an implementation tool kit, which includes discussions on whole blood program strategies and the process of developing detailed procedures on donor selection, collection, storage, and transfusion management of whole blood. The importance of training and audit of the routines is highlighted, and establishment of an emergency walking blood bank is discussed. We conclude that implementation of a whole blood program is achievable in small rural hospitals and recommend that rural health care facilities at all treatment levels enable early balanced transfusion for patients with life-threatening bleeding by establishing protocols for whole blood-based preparedness.


Assuntos
Bancos de Sangue , Transfusão de Componentes Sanguíneos , Seleção do Doador , Hemorragia/terapia , Hospitais Rurais , Ressuscitação , Hemorragia/sangue , Humanos
10.
Tidsskr Nor Laegeforen ; 140(12)2020 09 08.
Artigo em Norueguês | MEDLINE | ID: mdl-32900176

RESUMO

BACKGROUND: COVID-19 can lead to life-threatening disease. While awaiting vaccines or documented specific therapeutic agents, several alternative treatment options are under investigation. This is a case report of the first COVID-19 patient treated with convalescent plasma in Norway. CASE PRESENTATION: A patient with severe COVID-19 on prolonged mechanical ventilation, who was PCR SARS-Cov-2 positive on day 22, was transfused with convalescent plasma on day 31 and tested negative for SARS-CoV-2 the following day. The patient gradually improved and was weaned from the ventilator and discharged alive from the ICU on day 63. INTERPRETATION: This case report concerns one patient with clinical improvement after convalescent plasma transfusion. A SARS-CoV-2 test was not performed immediately before transfusion and the complexity of intensive care treatment makes it difficult to draw any conclusions on the potential effectiveness of this treatment. However, this case report is encouraging with regard to planned trials with convalescent plasma.


Assuntos
Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Betacoronavirus , COVID-19 , Humanos , Imunização Passiva , Noruega , Pandemias , SARS-CoV-2
11.
Anesthesiology ; 133(6): 1173-1183, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-32902572

RESUMO

BACKGROUND: This pilot trial focused on feasibility and safety to provide preliminary data to evaluate the hemostatic potential of cold-stored platelets (2° to 6°C) compared with standard room temperature-stored platelets (20° to 24°C) in adult patients undergoing complex cardiothoracic surgery. This study aimed to assess feasibility and to provide information for future pivotal trials. METHODS: A single center two-stage exploratory pilot study was performed on adult patients undergoing elective or semiurgent complex cardiothoracic surgery. In stage I, a two-armed randomized trial, platelets stored up to 7 days in the cold were compared with those stored at room temperature. In the subsequent single-arm stage II, cold storage time was extended to 8 to 14 days. The primary outcome was clinical effect measured by chest drain output. Secondary outcomes were platelet function measured by multiple electrode impedance aggregometry, total blood usage, immediate and long-term (28 days) adverse events, length of stay in intensive care, and mortality. RESULTS: In stage I, the median chest drain output was 720 ml (quartiles 485 to 1,170, n = 25) in patients transfused with room temperature-stored platelets and 645 ml (quartiles 460 to 800, n = 25) in patients transfused with cold-stored platelets. No significant difference was observed. The difference in medians between the room temperature- and cold-stored up to 7 days arm was 75 ml (95% CI, -220, 425). In stage II, the median chest drain output was 690 ml (500 to 1,880, n = 15). The difference in medians between the room temperature arm and the nonconcurrent cold-stored 8 to 14 days arm was 30 ml (95% CI, -1,040, 355). Platelet aggregation in vitro increased after transfusion in both the room temperature- and cold-stored platelet study arms. Total blood usage, number of adverse events, length of stay in intensive care, and mortality were comparable among patients receiving cold-stored and room temperature-stored platelets. CONCLUSIONS: This pilot trial supports the feasibility of platelets stored cold for up to 14 days and provides critical guidance for future pivotal trials in high-risk cardiothoracic bleeding patients.


Assuntos
Plaquetas/fisiologia , Preservação de Sangue/métodos , Procedimentos Cirúrgicos Cardíacos , Criopreservação/métodos , Transfusão de Plaquetas , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Agregação Plaquetária/fisiologia , Temperatura , Fatores de Tempo
12.
Transfusion ; 60(7): 1544-1551, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32319702

RESUMO

BACKGROUND: Increasing numbers of emergency medical service agencies and hospitals are developing the capability to administer blood products to patients with hemorrhagic shock. Cold-stored whole blood (WB) is the only single product available to prehospital providers who aim to deliver a balanced resuscitation strategy. However, there are no data on the safety and in vitro characteristics of prehospital stored WB. This study aimed to describe the effects on in vitro quality of storing WB at remote helicopter bases in thermal insulating containers. STUDY DESIGN AND METHODS: We conducted a two-armed single-center study. Twenty units (test) were stored in airtight thermal insulating containers, and 20 units (controls) were stored according to routine procedures in the Haukeland University Hospital Blood Bank. Storage conditions were continuously monitored during emergency medical services missions and throughout remote and blood bank storage. Hematologic and metabolic variables, viscoelastic properties, and platelet (PLT) aggregation were measured on Days 1, 8, 14, and 21. RESULTS: Storage conditions complied with the EU guidelines throughout remote and in-hospital storage for 21 days. There were no significant differences in PLT aggregation, viscoelastic properties, and hematology variables between the two groups. Minor significantly lower pH, glucose, and base excess and higher lactate were observed after storage in airtight containers. CONCLUSION: Forward cold storage of WB is safe and complies with EU standards. No difference is observed in hemostatic properties. Minor differences in metabolic variables may be related to the anaerobic conditions within the thermal box.


Assuntos
Resgate Aéreo , Glicemia/metabolismo , Plaquetas/metabolismo , Preservação de Sangue , Agregação Plaquetária , Plaquetas/citologia , Feminino , Humanos , Concentração de Íons de Hidrogênio , Masculino , Estudos Prospectivos , Fatores de Tempo
13.
Transfusion ; 60(5): 1042-1049, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32187700

RESUMO

BACKGROUND: Some jurisdictions require leukoreduction of cellular blood components. The only whole blood collection set with a platelet-saving filter uses citrate-phosphate-dextrose (CPD) as storage solution. Substituting CPD with citrate-phosphate-dextrose-adenine (CPDA-1) increases shelf life from 21 to 35 days. This would simplify prehospital and rural resupply and reduce wastage. We investigated in vitro quality and hemostatic properties of CPDA-1 whole blood leukoreduced with a platelet-saving filter. STUDY DESIGN AND METHODS: CPDA-1 whole blood was leukoreduced using a platelet-saving filter and stored 35 days. EDQM requirements, hematology, metabolic parameters, thromboelastography, light transmission aggregometry, fibrinogen, factor VIII, and interleukin-6 were measured on Days 0, 1, 14, 21, and 35 and compared to non-leukoreduced blood. RESULTS: All units met EDQM requirements. Leukoreduction yielded residual white blood cell count <1 × 106 and 87% platelet recovery on Day 1. It caused reduction in thromboelastography parameters, but not aggregometry response. No hemolysis >0.8% was observed. Factor VIII was higher on Day 35 in the leukoreduced group, 37.9 (95% CI: 26.0, 49.8) versus 13.8 (9.4, 18.2) IU/dL. In both groups, aggregation was significantly reduced by Day 14. Thromboelastography showed remaining platelet activity on Day 35, MA 46.9 (42.1, 51.7) in the leukoreduced and 44.3 (39.6, 49.0) mm in the non-leukoreduced group. Fibrinogen was within reference ranges at Day 35 (>2 g/dL). Interleukin-6 was not detectable. CONCLUSION: Leukoreducing CPDA-1 whole blood with a platelet-saving filter did not compromise hemostatic properties. We encourage development of a single bag CPDA-1 whole blood collection set with in-line platelet-saving filter.


Assuntos
Adenina/química , Preservação de Sangue/métodos , Coleta de Amostras Sanguíneas/métodos , Citratos/química , Temperatura Baixa , Glucose/química , Procedimentos de Redução de Leucócitos/métodos , Fosfatos/química , Adenina/farmacologia , Sangue/efeitos dos fármacos , Plaquetas/citologia , Plaquetas/efeitos dos fármacos , Preservação de Sangue/normas , Coleta de Amostras Sanguíneas/normas , Citratos/farmacologia , Filtração/métodos , Glucose/farmacologia , Hemólise/efeitos dos fármacos , Hemostasia/efeitos dos fármacos , Humanos , Técnicas In Vitro , Procedimentos de Redução de Leucócitos/normas , Fosfatos/farmacologia , Agregação Plaquetária/efeitos dos fármacos , Contagem de Plaquetas , Controle de Qualidade , Refrigeração/métodos
14.
Transfus Med ; 30(3): 201-209, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31926037

RESUMO

OBJECTIVES: The aim of this study was to measure blood concentrations of environmental pollutants in Norwegian donors and evaluate the risk of pollutant exposure through blood transfusions. BACKGROUND: Transfused blood may be a potential source of exposure to heavy metals and organic pollutants and presents a risk to vulnerable patient groups such as premature infants. METHODS/MATERIALS: Donors were randomly recruited from three Norwegian blood banks: in Bergen, Tromsø and Kirkenes. Selected heavy metals were measured in whole blood using inductively coupled plasma mass spectrometry (ICP-MS), and perfluoroalkyl substances (PFAS) were measured in serum by ultrahigh-pressure liquid chromatography coupled with a triple-quadrupole mass spectrometer (UHPLC-MS/MS). RESULTS: Almost 18% of blood donors had lead concentrations over the limit suggested for transfusions in premature infants (0.09 µmol/L). About 11% of all donors had mercury concentrations over the suggested limit of 23.7 nmol/L. Cadmium was higher than the limit, 16 nmol/L, in 4% of donors. Perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS) concentrations were over the suggested limit of 0.91 ng/mL in 68% and 100% of the donors, respectively. PFAS concentrations and heavy metal concentrations increased with donor's age. CONCLUSION: A considerable percentage of donors had lead, PFOS and PFOA concentrations over the suggested limits. In addition, at each study site, there were donors with high mercury and cadmium concentrations. Selecting young donors for transfusions or measurements of pollutants in donor blood may be a feasible approach to avoid exposure through blood transfusions to vulnerable groups of patients such as premature infants.

15.
Transfusion ; 59(8): 2652-2661, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31150571

RESUMO

BACKGROUND: Cold storage of platelets may extend shelf life compared to room temperature storage. This study aimed to investigate in vitro platelet quality and function in cold-stored and delayed-cold-stored nonagitated apheresis platelets in platelet additive solution during storage for 21 days. STUDY DESIGN AND METHODS: Ten double apheresis platelet concentrates in 37% plasma/63% PAS-IIIM were split into two groups; nonagitated 2 to 6°C storage (CSPs) and delayed cold storage (DCSPs) with 7 days agitated storage at 20-24°C followed by nonagitated cold storage for 14 additional days. Platelet count, metabolism, viscoelastic properties, and aggregation ability were measured on Days 1, 7, 14, and 21. RESULTS: All platelet units, both CSPs and DCSPs, complied with the EU guidelines throughout storage for 21 days. Swirling was not detectable after cold storage. Cold storage improved platelet function; however, DCSP on Day 7 showed poorer results compared to CSP. Cold storage slowed down metabolism, with lower lactate and higher glucose concentrations in the CSP compared to the DCSP throughout storage for 21 days. CONCLUSION: Cold storage of platelets improved platelet function in in vitro assays, even though delayed cold storage on Day 7 showed poorer results compared to continuous cold storage. This difference could be explained by accelerated metabolism and higher glucose consumption during the period of room temperature storage. Cold storage and delayed cold storage could ease inventory management. Further studies investigating the in vitro and clinical effects of cold-stored and delayed-cold-stored platelets are encouraged.


Assuntos
Plaquetas/metabolismo , Preservação de Sangue , Temperatura Baixa , Plaquetoferese , Plaquetas/citologia , Feminino , Humanos , Masculino , Testes de Função Plaquetária , Estudos Prospectivos , Fatores de Tempo
16.
Transfusion ; 59(S2): 1446-1452, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30980744

RESUMO

The shift toward using a transfusion strategy in a ratio to mimic whole blood (WB) functionality has revitalized WB as a viable option to replace severe blood loss in civilian health care. A military-civilian collaboration has contributed to the reintroduction of WB at Haukeland University Hospital in Bergen, Norway. WB has logistical and hemostatic advantages in both the pre- and in-hospital settings where the goal is a perfectly timed balanced transfusion strategy. In this paper, we describe an event leading to activation of our emergency WB collection strategy for the first time. We evaluate the feasibility of our civilian walking blood bank (WBB) to cover the need of a massive amount of blood in an emergency situation. The challenges are discussed in relation to the different stages of the event with the recommendations for improvement in practice. We conclude that the use of pre-screened donors as a WBB in a civilian setting is feasible. The WBB can provide platelet containing blood components for balanced blood resuscitation in a clinically relevant time frame.


Assuntos
Bancos de Sangue , Doadores de Sangue , Segurança do Sangue , Seleção do Doador , Hospitais Militares , Medicina Militar , Bancos de Sangue/organização & administração , Bancos de Sangue/normas , Segurança do Sangue/métodos , Segurança do Sangue/normas , Seleção do Doador/organização & administração , Seleção do Doador/normas , Feminino , Hospitais Militares/organização & administração , Hospitais Militares/normas , Humanos , Masculino , Medicina Militar/métodos , Medicina Militar/organização & administração , Medicina Militar/normas , Noruega
17.
Blood Transfus ; 17(3): 181-190, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30747706

RESUMO

BACKGROUND: In thrombocytopenic patients better assessment of bleeding risk than that provided by platelet count alone is required. Multiplate® aggregometry and thromboelastography (TEG) could be used, but information on their role in such patients is limited. The primary aim of this study was to investigate the feasibility of Multiplate® analyses in patients with haematological malignancies. A secondary aim was to explore whether a multiple logistic regression model combining Multiplate®, TEG, clinical and laboratory variables was associated with risk of bleeding. MATERIALS AND METHODS: This was an exploratory, prospective observational study of thrombocytopenic patients with haematological malignancies. Total platelet count (TPC), white blood cell count, C-reactive protein (CRP) level, temperature and bleeding status were recorded daily. TEG and Multiplate® analyses with four agonists were performed on weekdays. RESULTS: Ten patients were enrolled into the study. The median number of days in a study period was 21. Bleeding was observed on 64 of 298 study days. TPC <20×109/L and <10×109/L occurred on 119 and 25 days, respectively. When TPC was <33×109/L, many samples showed no aggregation, regardless of bleeding status. Despite this, the odds of World Health Organization (WHO) grade 2 bleeding decreased significantly as aggregation increased and Multiplate® had a negative predictive value (NPV) of 96% and a positive predictive value (PPV) of 19% for significant bleeding. In the multiple logistic regression model collagen-activated Multiplate® aggregation, TEG angle, TEG reaction time and CRP significantly affected the odds of WHO grade 2 bleeding. The combined model had a NPV of 99% and a PPV of 19%. DISCUSSION: Our findings suggest that the markers of platelet function and haemostasis provided by Multiplate® aggregometry and TEG may add information to support prediction of bleeding, although platelet count still remains the most accessible analysis for routine testing.


Assuntos
Plaquetas/metabolismo , Neoplasias Hematológicas/sangue , Agregação Plaquetária , Tromboelastografia , Trombocitopenia/sangue , Adulto , Feminino , Hemorragia/sangue , Humanos , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Testes de Função Plaquetária , Estudos Prospectivos
18.
Transfus Apher Sci ; 58(1): 117-121, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30616957

RESUMO

Thromboelastography (TEG) has been part of the assessment of patients receiving massive transfusion (MT) at Haukeland university hospital (HUH) since 2007. However, the test has been used inconsistently, and in general, the value of the test in evaluation of patients with critical bleeding is still debated, although it has been suggested that the TEG-guided treatment decreases blood usage. This single-centre retrospective study examines the use of TEG and discusses its place as part of assessing MT patients. The study focuses on the amount of blood product transfused in TEG-tested and non-TEG tested patients and whether TEG assisted coagulation therapy has affected mortality compared to conventional coagulation tests (CCTs). The study is based on the data from the massive transfusion study (MTS) 2002-15. 241 MT patients were identified, and they were grouped into patients assessed with TEG and patients who did not get this evaluation. In a sub-analysis, the patients with the initially (first TEG-test) 30 best and 30 worst TEG curves were defined based on normal ranges for the parameters R-time, α-angle, Maximal Amplitude (MA) and lysis after 30 min (LY). Survival rate and blood product usage were compared between these groups and between TEG and non-TEG patients. 111 patients were tested with TEG and 130 were not. The patients with highly pathological TEG curves (worst) have significantly higher mortality than the 30 normal-TEG patients (best) after 24 h (p < 0.001), 5 days (p < 0.05) and 30 days (p < 0.05). The best group had significantly lower mortality than the non TEG-group (p < 0.001). The difference in mortality between TEG and non-TEG patients overall was not statistically significant (p = 0.679). The TEG patients received more blood transfusions than non-TEG patients, (p < 0.001) and the patients with the worst TEG curves received the highest number of blood components. The use of TEG is debated in patients with critical bleeding. This study shows that TEG-testing is variably used in the assessment of massively bleeding patients at Haukeland University Hospital. 43.2% of 241 patients receiving massive transfusion packs were tested by TEG. When we compared the patients with the 30 best TEG curves with the 30 worst curves, there was a significantly better survival in the "best" group - without any significant difference in blood component usage. This study was not designed to provide causal information, but despite the limitations, the study indicates that the role of TEG in this patient group should be further evaluated.


Assuntos
Hemorragia/terapia , Tromboelastografia/métodos , Feminino , História do Século XXI , Hospitais Universitários , Humanos , Masculino , Noruega
19.
Vox Sang ; 113(7): 657-668, 2018 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30159896

RESUMO

BACKGROUND AND OBJECTIVES: In a previous pilot study, we demonstrated significantly lower haemoglobin (Hb) increment after red-blood-cell (RBC) transfusions in febrile patients compared to patients without fever. The aim of this study was to examine associations between inflammatory mediators and post-transfusion haemoglobin increment in patients with haematological diseases. MATERIALS AND METHODS: Twenty-seven patients (eight women, 19 men), median age 56 years receiving RBC transfusion, were included in the study. Hb increment per unit transfused was corrected for estimated patient blood volume and the amount of Hb transfused. A wide spectrum of inflammatory mediators was determined by multiplex technology. Association between post-transfusion haemoglobin increment, plasma inflammatory mediators and patient characteristics was analysed using a mixed linear regression model. RESULTS: Febrile patients had significantly lower corrected Hb increment, significantly increased values of IL-6, IL-8, IL-10 and G-CSF, significantly reduced levels of CCL5 and CXCL10, and significantly higher pretransfusion levels of CRP. There was a significant association between pretransfusion CRP levels and corrected Hb increment for the whole patient cohort, but not within each of the two groups. Results demonstrated an association between haemoglobin increment, fever and inflammatory mediators. Febrile patients had a significantly lower corrected Hb increment compared to nonfebrile patients, when adjusting for mediators. When fever was kept constant, a significant negative association between haemoglobin increment and the proinflammatory mediators IL-6 and IL-8 was observed. CONCLUSION: Both fever and the inflammatory mediators IL-6 and IL-8 were negatively associated with post-transfusion haemoglobin increment.


Assuntos
Febre/sangue , Doenças Hematológicas/sangue , Hemoglobinas/análise , Interleucinas/sangue , Adulto , Idoso , Transfusão de Eritrócitos , Feminino , Doenças Hematológicas/terapia , Humanos , Masculino , Pessoa de Meia-Idade
20.
Blood ; 132(2): 223-231, 2018 07 12.
Artigo em Inglês | MEDLINE | ID: mdl-29773572

RESUMO

Pathogen inactivation of platelet concentrates reduces the risk for blood-borne infections. However, its effect on platelet function and hemostatic efficacy of transfusion is unclear. We conducted a randomized noninferiority trial comparing the efficacy of pathogen-inactivated platelets using riboflavin and UV B illumination technology (intervention) compared with standard plasma-stored platelets (control) for the prevention of bleeding in patients with hematologic malignancies and thrombocytopenia. The primary outcome parameter was the proportion of transfusion-treatment periods in which the patient had grade 2 or higher bleeding, as defined by World Health Organization criteria. Between November 2010 and April 2016, 469 unique patients were randomized to 567 transfusion-treatment periods (283 in the control arm, 284 in the intervention arm). There was a 3% absolute difference in grade 2 or higher bleeding in the intention-to-treat analysis: 51% of the transfusion-treatment periods in the control arm and 54% in the intervention arm (95% confidence interval [CI], -6 to 11; P = .012 for noninferiority). However, in the per-protocol analysis, the difference in grade 2 or higher bleeding was 8%: 44% in the control arm and 52% in the intervention arm (95% CI -2 to 18; P = .19 for noninferiority). Transfusion increment parameters were ∼50% lower in the intervention arm. There was no difference in the proportion of patients developing HLA class I alloantibodies. In conclusion, the noninferiority criterion for pathogen-inactivated platelets was met in the intention-to-treat analysis. This finding was not demonstrated in the per-protocol analysis. This trial was registered at The Netherlands National Trial Registry as #NTR2106 and at www.clinicaltrials.gov as #NCT02783313.


Assuntos
Plaquetas/metabolismo , Hemostasia , Transfusão de Plaquetas , Coagulação Sanguínea , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Estudos Multicêntricos como Assunto , Avaliação de Resultados da Assistência ao Paciente , Testes de Função Plaquetária , Transfusão de Plaquetas/efeitos adversos , Transfusão de Plaquetas/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto
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