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Introduction: Our commitment to provide quality cord blood units (CBUs) to patients in need was challenged with the outbreak of COVID-19 and the pandemics continued impact through early 2022. We continually monitored the ever-evolving COVID-19 public health threat to make adjustments to our practices to achieve optimal collections while maintaining the safety and quality of our CBUs. Objective: The CCBC continued collections at all five collection sites with a brief mandated pause at our California site due to hospital restrictions. We maintained minimal staffing at the cord blood center to reduce the number of employees impacted should an exposure occur. Donors were screened upon admission for symptoms, exposure, positive testing, and recent vaccination, and donors with identified risks were excluded from collection. Methods: Our study design takes a retrospective look at data collected from the onset of the COVID-19 pandemic through December 2021 compared to data from 2018-2019. Factors included were birth numbers, number of patients testing positive for COVID-19, and staffing shortages due to coordinator illness with COVID-19. Results: We saw limited impact to our collection staff at the hospital or on site at the CCBC. Our biggest reduction of donors consented was between 2019 and 2020, which we attribute to the COVID peak and introduction of vaccinations. Most sites were trending downward for consenting on a yearly basis before COVID-19 at a rate of 6%-10% per year;during 2019-2020 we saw 19%, but the trend has returned to 8% from 2020-2021. This same trending occurred during the ZIKA outbreak. There was no further data review to determine if these mothers would have been excluded for other reasons. We collected a total of 15,561 units between 2018 and 2019 and a total of 10,121 units between 2020 and 2021. Discussion: Overall productivity of the collections was not dramatically affected by our response to the COVID-19 pandemic. Further research at time of pre-consent, to determine if the mother would have been ineligible to donate for reasons other than COVID-19, would have given us a more accurate count of donors lost for reasons related to the COVID-19 pandemic.
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Background : SARS-CoV-2 infection can trigger an important immune reaction, induce antiphospholipid antibodies, and is associated with a high-risk of venous thromboembolism (VTE), especially in patients with severe or critical disease. Hydroxychloroquine is an immunomodulator that had proven some efficacy in preventing thrombosis in antiphospholipid syndrome. Aims : To investigate if hydroxychloroquine prevents symptomatic VTE in patients with mild to moderate COVID-19. Methods : Ancillary study of HYCOVID trial, a prospective, multicenter, randomized, double-blind trial aiming to assess the efficacy of hydroxychloroquine with regard to the 14-day rate of death or invasive ventilation ( https://clini caltr ials.gov/ct2/show/NCT04 325893 ). COVID-19 patients were included, with their informed consent, if they had at least one of the following risk factors for worsening: need for supplemental oxygen, age ≥75 years, age between 60 -74 years and presence of at least one comorbidity. Eligible patients were randomized to receive either 800 mg hydroxychloroquine on Day 0 followed by 400 mg per day for 8 days, or a placebo. In the present study, we assessed the 28-day cumulative rate of symptomatic VTE. All suspected events were adjudicated by an independent committee, blinded to treatment allocation. Results : Two hundred and fifty patients were enrolled;124 and 123 patients received hydroxychloroquine or placebo and were included in the modified intention-to-treat analysis, respectively. Eightyseven percent of the patients received an anticoagulant treatment during hospitalization (104 [83.9%] and 111 [91.2%] in the hydroxychloroquine and the placebo group, respectively) (Table). Two patients in each group experienced VTE within the 28 days following inclusion. All events were pulmonary embolism (PE), including one fatal PE in the placebo group. The VTE rate was 1.61% (95%CI: 0.20 to 5.70) in the hydroxychloroquine group and 1.63% (95% confidence interval: 0.20 to 5.75) in the placebo group ( P = 1.00). Conclusions : In patients hospitalized for mild to moderate COVID-19, the rate of symptomatic VTE was low with no evidence of benefit of hydroxychloroquine.
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BACKGROUND: The impact of the first coronavirus disease 2019 (COVID-19) wave on cancer patient management was measured within the nationwide network of the Unicancer comprehensive cancer centers in France. PATIENTS AND METHODS: The number of patients diagnosed and treated within 17 of the 18 Unicancer centers was collected in 2020 and compared with that during the same periods between 2016 and 2019. Unicancer centers treat close to 20% of cancer patients in France yearly. The reduction in the number of patients attending the Unicancer centers was analyzed per regions and cancer types. The impact of delayed care on cancer-related deaths was calculated based on different hypotheses. RESULTS: A 6.8% decrease in patients managed within Unicancer in the first 7 months of 2020 versus 2019 was observed. This reduction reached 21% during April and May, and was not compensated in June and July, nor later until November 2020. This reduction was observed only for newly diagnosed patients, while the clinical activity for previously diagnosed patients increased by 4% similar to previous years. The reduction was more pronounced in women, in breast and prostate cancers, and for patients without metastasis. Using an estimated hazard ratio of 1.06 per month of delay in diagnosis and treatment of new patients, we calculated that the delays observed in the 5-month period from March to July 2020 may result in an excess mortality due to cancer of 1000-6000 patients in coming years. CONCLUSIONS: In this study, the delays in cancer patient management were observed only for newly diagnosed patients, more frequently in women, for breast cancer, prostate cancer, and nonmetastatic cancers. These delays may result is an excess risk of cancer-related deaths in the coming years.
Subject(s)
COVID-19 , Neoplasms/complications , COVID-19/complications , Female , France , Humans , Male , SARS-CoV-2ABSTRACT
SESSION TITLE: Critical Care Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: October 18-21, 2020 PURPOSE: Sepsis is defined as a Life-Threatening Organ Dysfunction caused by a dysregulated Host Response to Infection.The latter involves an Inflammation Activation,with an Over-Production of Pro-Inflammatory Cytokines("Cytokine Storm").This can lead to a Sepsis-Associated Coagulopathy(SAC/Overt vs NON-Overt DIC).SAC includes 3 Mechanisms:Activation of Coagulation Cascade,Down-Regulation of Natural Anticoagulants,Inhibition of Endogenous Fibrinolysis.This may cause an increased Fibrin Formation & Deposition,leading to a Thrombotic Obstruction of the Microvasculature.It may thus play a role in the Pathogenesis of Multiple Organ Failure(MOF).The aim of our study was to create a Novel Hemostatic Score(NHS),and see if ONE of the FIVE Hematologic Biomarkers,used in our NHS,could prove to be more potent,to help us identify High-Risk patients with SAC. METHODS: Our NHS was elaborated to evaluate patients with SAC.This NHS was built on the basis of the ISTH/DIC Scoring System.We have decided to delete Fibrinogen(An Acute Phase Reactant),& to add Protein-C(PC)+Antithrombin-III(AT)(Natural Anticoagulants).74 patients admitted to our ICU with a diagnosis of Sepsis,were included and screened for Mortality at one month,Number of Organs showing an Acute Dysfunction(NOD),Serial Biomarkers,& Calculation of our NHS(Described in CritCareMed,Dec.2012Suppl.Abst.818 & CHEST2014;146:233A). RESULTS: All-Cause Mortality was 55%(41/74).The 41 patients who died had an Average of 5.5NOD,while the 33 Survivors had a mean NOD of 3.5(p<0.001).Patients who died had a mean NHS of 8.8 points,compared to 6.6 in Survivors(p=0.001).Mean PC values were 0.34Un/l in patients who died,compared to 0.53 in Survivors(p<0.001).Mean AT values were 0.41Un/l in people who died,compared to 0.55 in Survivors(p=0.002).Average Platelet Counts were 101K in patients who died,& 154K in Survivors(p=0.011).We have detected an unequivocal cutoff value for PC,at 0.50Un/l.Patients with PC values < or = 0.49,had an Average of 5.2NOD,a mean NHS of 9.1 points,& a Rate of Mortality of 71%.Patients with PC values > or = 0.50,had an Average of 3.3NOD,a mean NHS of 4.7points,& a Rate of Mortality of 18%.All the comparisons made between the 2 groups,for the 3 values,were statistically significant(p<0.001). CONCLUSIONS: Our study has showed a clear relationship between the severity of SAC and a poor outcome.DIC has now been recognized as an Independant Predictor of Mortality.Low values of PC & AT,and a high NHS,were associated with high NOD,and an increased risk of MODS & Mortality.Our NHS was built on the basis of the ISTH/DIC Scoring System.The latter has the advantage of taking into account the 3 Mechanisms of SAC.The Data presented here has showed that PC was the most potent Hematologic Biomarker(When compared to the 4 other used in the algorithm of our NHS),to identify high-risk patients with Sepsis & SAC. CLINICAL IMPLICATIONS: We have proven that Bacterial Sepsis can imply a significant Host Response that may lead to clot production in the Microvasculature, and consequently,hypoxia of Vital Organs,leading to Organ Dysfunction & Failure.Pneumococcus & Meningococcus are probably the two most agressive bacteria.PC and our NHS have identified the most severe SAC,& could help identify the most severe COVID-19 patients with DIC & poor prognosis.Recombinant human Activated Protein-C(rhAPC),an Anti-Inflammatory,Antithrombotic,Anticoagulant,& Pro-Fibrinolytic Rx,could help decrease complications of the COVID-19 most severe Infections.RCT Studies are needed to re-investigate rhAPC in patients with Sepsis,but utilizing hematologic inclusion criteria. DISCLOSURES: No relevant relationships by Sylvie Boucher, source=Web Response No relevant relationships by Jean-Francois Mathieu, source=Web Response