ABSTRACT
Background: Vaccination is considered the most promising approach for ending or containing the coronavirus disease 2019 (COVID-19) pandemic. Available vaccines have proven highly safe and effective. The morphology appearance of the blood film is an excellent tool to analyse the disease severity. In late February of 2021, a prothrombotic syndrome was observed in a small number of individuals who received the ChAdOx1 CoV-19 vaccine (AstraZeneca, University of Oxford, and Serum Institute of India), an adenoviral vector-based vaccine. This syndrome has been designated vaccine-induced immune thrombotic thrombocytopenia (VITT) with a particular and intriguing characteristic. Aims: An examination of peripheral blood smear findings in COVID-19 patients was performed in 50 consecutive patients at the first wave of the disease and prior to the full vaccination program instituted with current-acute respiratory syndrome coronavirus 2 (SARS-CoV-2) confirmed disease (PCR)-Pneumonia Methods: A morphology analysis was aimed at identifying the principal abnormalities in patients diagnosed with COVID-19. Interestingly (but not surprisingly) the most severe forms were associated with a more prominent abnormalities, including leukoerythorblastic features and secondary hemophagocytic lymphohistiocytosis, leading to an often fatal outcomes. In this study, absolute lymphopenia (despite non constant) were the predominant feature despite its not specific to COVID-19. A spectrum of variant lymphocytes is seen in COVID-19 cases, albeit constituting less than 1% prolymphocytes in most cases. Plasmacytoid lymphocytes were more common as well as acquired Pelger-Huët were significantly observed (but not representative). Results: A laboratory findings reported in association with COVID-19 included leukopenia, lymphopenia, monocytosis, neutrophilia, eosinopenia, These abnormalities mainly highlight the severe, transitory and reversible perturbation of myelopoiesis, especially in the form of accelerated and disordered granulopoiesis, in patients with COVID19 in severe symptomatic phase. The hypothesis of quantitative and qualitative abnormalities can be related to the cytokine storm and hyperinflammation, which is a pathogenic factor in the evolution of COVID19 pneumonia. Summary/Conclusion: An early identification of severe lymphoid abnormality could represent a high risk factor for poor outcomes with COVID-19. A decreased number of mature lymphocytes, and eosinophils in peripheral blood smear were observed in the severe stage patients (p <0.05). The limitation of the study is in the small numbers of the analysed population and the absent of the control comparative group. The subsequent analysis after patient received at least two dose of the vaccination shows a less severe lymphopenia (P< 0.05) and disease severity.
ABSTRACT
Background: There is universal concern about the inappropriate use of fresh frozen plasma (FFP). Earlier investigations have indicated that FFP may be associated with high rates of inappropriate transfusion, with some studies indicating rates of up to 50% non-compliance with established guidelines. The current British Committee for Standards in Haematology (BCSH) guidelines on the use of FFP aim to reinforce the message regarding avoidance of its inappropriate use. Aims: Audit the use of appropiate FFP in the context of the COVID pandemia. Methods: Retrospective analysis of requests for plasma transfusion in adults, in our institution, between January/2020 and January/2022, This audit was undertaken to determine current use of FFP and to see if any improvements in the use of this component in relation to recommended guidance. May be we use more FFP due to covid situation. The data was obtained by consulting the Integrated System of Blood Banks. Results: During the study period, 98 units of FFP were used for 'acute' episodes including management of acute COVID complications. Only 67% of these transfusion episodes were deemed appropriate, based on the BSH criteria. This also means that 13 units of FFP may have been wasted. FFP is used by both medical and surgical specialties with general surgery, general medicine and neurosurgery being the main users. During the study period, 98 units of FFP were used for 'acute' episodes including management of acute COVID complications. Only 67% of these transfusion episodes were deemed appropriate, based on the BSH criteria. This also means that 13 units of FFP may have been wasted. FFP is used by both medical and surgical specialties with general surgery, general medicine and neurosurgery being the main users. 159 requests for plasma were registered in the analyzed period. In most cases (98), the reason was hemorrhage due to multiple factor deficiencies, including liver disease, trauma, lung disease or a massive transfusion. Prophylactic/therapeutic replacement of congenital factor XI deficiency, associated with bleeding episodes, was indicated in 2 situations. In 1 case, the indication was treatment of HUS and 2 cases of HELLP syndrome. In 7 cases, there was an overlapping of indications. In 7 cases, plasma was administered in unforeseen situations, such as for the correction of laboratory abnormalities without clinical manifestations (4 cases) or for prophylaxis of invasive techniques without abnormal coagulation tests (2 cases). Summary/Conclusion: The proportion of inappropriate requests is similar between surgical and non-surgical specialties and also when broken down into individual departments, the number of inappropriate requests consistently outnumbers appropriate requests across all departments. FFP continues to be frequently used in the absence of bleeding and / or evidence of abnormal coagulation, thus highlights the need for concerted efforts in the education of clinicians who prescribe FFP. In the analysis of the indications for plasma prescription, it is concluded that in 17 % cases the indication was not complete adequately or justifable. 7% of cases given FFP had no record of post-transfusion coagulation data. Following this work, dissemination coupled with education was undertaken. The use of FFP for Warfarin reversal has correctly indicated (> 95%). it may suggest that an education programmes directed at specific aspects of practice do influence clinical behaviour over needs to be addressed.