ABSTRACT
Background: It is well knowledge that various viral illnesses may interfere with a man's ability to father children. Through the angiotensin-converting enzyme-2 receptor, which is highly concentrated in testicular tissue, the corona virus illness known as COVID-19 may cause harm to several organs. On the other hand, there is a paucity of data about the transmission of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) in sperm, as well as the virus's influence on spermatogenesis and the capacity for fertility. We intended to look into whether or not COVID-19 guys' sperm contained SARS-CoV-2 as well as examine how COVID-19 affected the overall quality of the sperm and the degree to which it's DNA was fragmented. Material(s) and Method(s): The survey was conducted between May 2022 to October 2022, with the participation of 40 male COVID-19 patients who were between the ages of 19 and 45 and enrolled at the RSDKS, Government Medical College, Ambikapur, Chhattisgarh. We tested each sample of sperm with a real-time reverse transcriptase and found no abnormalities. At the time of the initial sample, which took place during COVID-19, a comprehensive examination of the sperm was carried out. This analysis included the calculation of the sperm DNA Fragmentation Index. After 74 days had passed since the first sample, we were able to get the second specimen and carried out the aforementioned tests once again. Result(s): All of the sperm samples that were examined using real-time reverse transcription-polymerase chain reaction (RT-PCR) came back negative for SARS-CoV-2. These samples were taken during the first and second sampling. The initial sample had considerably lower levels of fructose, semen volume, vitality, total motility, sperm concentration, total sperm count, percentage of normal morphology, and cytoplasmic droplet percentage than the subsequent samples. On the other hand, the agglutination of the semen, the percentage of head defects, the DNA Fragmentation Index, the liquefaction time, the viscosity of the semen, and the number of leukocytes all rose. At the second sample, these results were inverted, but not to the level that would be considered optimal. These results all had a p-value less than 0.05, meaning they were statistically significant. As a result, COVID-19 has a detrimental impact on the characteristics of the sperm, including the sperm DNA fragmentation index. Conclusion(s): The quality of the semen remained low up until the second time it was sampled, despite the fact that we were unable to discover SARS-CoV-2 in the sample. It is recommended that assisted reproductive technology (ART) clinics and sperm banking facilities evaluate the quality of the sperm produced by males infected with COVID-19 and exclude men who have a history of being infected with SARS-CoV-2 until the men's sperm quality recovers to normal.Copyright © 2023 Ubiquity Press. All rights reserved.
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Biomarker detection has attracted increasing interest in recent years due to the minimally or non-invasive sampling process. Single entity analysis of biomarkers is expected to provide real-time and accurate biological information for early disease diagnosis and prognosis, which is critical to the effective disease treatment and is also important in personalized medicine. As an innovative single entity analysis method, nanopore sensing is a pioneering single-molecule detection technique that is widely used in analytical bioanalytical fields. In this review, we overview the recent progress of nanopore biomarker detection as new approaches to disease diagnosis. In highlighted studies, nanopore was focusing on detecting biomarkers of different categories of communicable and noncommunicable diseases, such as pandemic COVID-19, AIDS, cancers, neurologic diseases, etc. Various sensitive and selective nanopore detecting strategies for different types of biomarkers are summarized. In addition, the challenges, opportunities, and direction for future development of nanopore-based biomarker sensors are also discussed.Copyright © 2023 Elsevier B.V.
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Cold agglutinin disease(CAD) is an autoimmune disease that occurs against erythrocyte antigens. It is usually idiopathic, but some infections can also be a trigger. CAD becomes active in the peripheral circulation at lower temperatures more easily when exposed to cold, causing hemolysis or agglutination. In this article, the management of a coronary bypass case with CA formation in intraoperative period is presented. A 46-year-old diabetic and hypertensive male patient had COVID-19 2 months ago. Cardiopulmonary bypass(CPB) was initiated with adequate heparinization, and the patient was cooled to 32degreeC. It was noticed that there were clots in the cardioplegia delivery line(+1degreeC). Agglutinations were observed in the autologous blood of the patient whose ACT values were normal. After CPB, the operation was completed without any problems and the patient was discharged on the 5th day with recovery. A diagnosis of CAD was made with the results of peripheral smear and immunologic tests. Determination of antibody concentration and thermal amplitude in the preoperative period in patients with CAD is very important. While preparing such patients for surgery, heating of room, patient, fluids, planning of normothermic CPB, and using warm cardioplegia are required. The relationship between CAD and COVID has started to take place in the literature. The patient we presented had a COVID 2 months ago, cold agglutinin may have been induced by COVID or may have arisen idiopathic. Considering that many people may have had a COVID nowadays, care should be taken especially in the perioperative period of cardiac surgery.Copyright © Telif hakki 2022 Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi - Available online at www.gkdaybd.org.
ABSTRACT
Cold agglutinin disease(CAD) is an autoimmune disease that occurs against erythrocyte antigens. It is usually idiopathic, but some infections can also be a trigger. CAD becomes active in the peripheral circulation at lower temperatures more easily when exposed to cold, causing hemolysis or agglutination. In this article, the management of a coronary bypass case with CA formation in intraoperative period is presented. A 46-year-old diabetic and hypertensive male patient had COVID-19 2 months ago. Cardiopulmonary bypass(CPB) was initiated with adequate heparinization, and the patient was cooled to 32degreeC. It was noticed that there were clots in the cardioplegia delivery line(+1degreeC). Agglutinations were observed in the autologous blood of the patient whose ACT values were normal. After CPB, the operation was completed without any problems and the patient was discharged on the 5th day with recovery. A diagnosis of CAD was made with the results of peripheral smear and immunologic tests. Determination of antibody concentration and thermal amplitude in the preoperative period in patients with CAD is very important. While preparing such patients for surgery, heating of room, patient, fluids, planning of normothermic CPB, and using warm cardioplegia are required. The relationship between CAD and COVID has started to take place in the literature. The patient we presented had a COVID 2 months ago, cold agglutinin may have been induced by COVID or may have arisen idiopathic. Considering that many people may have had a COVID nowadays, care should be taken especially in the perioperative period of cardiac surgery.Copyright © Telif hakki 2022 Gogus-Kalp-Damar Anestezi ve Yogun Bakim Dernegi Dergisi - Available online at www.gkdaybd.org.
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INTRODUCTION: Autoimmune hematological complications related to COVID-19 are rare. There are only 5 pediatric case reports of autoimmune hemolytic anemia (AIHA) among 14 million pediatric COVID-19 cases in USA. Four were older (13-17 years), two had underlying autoimmune/hematologic conditions. Immunologic analysis varied, with cold, warm & mixed hemolytic anemias described. We present a previously healthy child with COVID-19 associated severe AIHA with peripheral reticulocytopenia. DESCRIPTION: A 3-year-old male presented with lethargy, fever, tachycardia and jaundice 10 days after COVID-19 diagnosis. Pertinent labs include hemoglobin (Hgb) 3.8 g/dL, Hct 9.9%, bilirubin 3.6 mg/dL, platelets 321,000/muL, RBC count 1.2 M/muL, WBC 35,600/muL, MCV 82.5fL. Reticulocyte count (RC) was only 2.8%. Peripheral blood smear showed anisocytosis, poikilocytosis, nucleated RBCs and left shifted granulocytosis. Bone marrow biopsy revealed erythroid hyperplasia without underlying malignancy;myeloid:erythroid ratio of 0.3:1. The outside hospital reported cold C3 agglutination following 4degreeC incubation, while our laboratory identified spontaneous agglutination at room temperature (warm agglutination). IV fluids, O2, and methylprednisolone (4 mg/kg/day) were started and two packed RBC transfusions (total 30 ml/kg) given for symptomatic anemia with Hgb < 4 g/dL. LDH peaked at 2255 U/L on Day 3. Reticulocyte count was low (2.8%-3.8%) Days 1-3, increased to 6.5% on Day 4 and peaked at >30.0% on Day 7. He was changed to oral prednisone 2 mg/kg/day on Day 12 and discharged on Day 13 with Hgb 7.0 g/dL and RC 29.9%. Most recent Hgb is 13.0 g/dL and RC 2.6%. DISCUSSION: COVID-19 associated AIHA is rare, and previously reported mostly in older children. Our patient was previously healthy, and demonstrated a strong bone marrow response with erythroid hyperplasia. Peripheral reticulocytosis was delayed, and correlated with initiation of systemic steroid therapy. Our patient had both cold and warm agglutination supporting extensive autoimmune destruction of early red cell lineage. These findings support immune activation during acute COVID-19 infection and COVID-19 as a trigger for AIHA. Patients developing AIHA may need to be tested for COVID-19 and carefully monitored for complications.
ABSTRACT
Background: It is well knowledge that various viral illnesses may interfere with a man's ability to father children. Through the angiotensin-converting enzyme-2 receptor, which is highly concentrated in testicular tissue, the corona virus illness known as COVID-19 may cause harm to several organs. On the other hand, there is a paucity of data about the transmission of severe acute respiratory syndrome corona virus-2 (SARS-CoV-2) in sperm, as well as the virus's influence on spermatogenesis and the capacity for fertility. We intended to look into whether or not COVID-19 guys' sperm contained SARS-CoV-2 as well as examine how COVID-19 affected the overall quality of the sperm and the degree to which it's DNA was fragmented. Material(s) and Method(s): The survey was conducted between May 2022 to October 2022, with the participation of 40 male COVID-19 patients who were between the ages of 19 and 45 and enrolled at the RSDKS, Government Medical College, Ambikapur, Chhattisgarh. We tested each sample of sperm with a real-time reverse transcriptase and found no abnormalities. At the time of the initial sample, which took place during COVID-19, a comprehensive examination of the sperm was carried out. This analysis included the calculation of the sperm DNA Fragmentation Index. After 74 days had passed since the first sample, we were able to get the second specimen and carried out the aforementioned tests once again. Result(s): All of the sperm samples that were examined using real-time reverse transcription-polymerase chain reaction (RT-PCR) came back negative for SARS-CoV-2. These samples were taken during the first and second sampling. The initial sample had considerably lower levels of fructose, semen volume, vitality, total motility, sperm concentration, total sperm count, percentage of normal morphology, and cytoplasmic droplet percentage than the subsequent samples. On the other hand, the agglutination of the semen, the percentage of head defects, the DNA Fragmentation Index, the liquefaction time, the viscosity of the semen, and the number of leukocytes all rose. At the second sample, these results were inverted, but not to the level that would be considered optimal. These results all had a p-value less than 0.05, meaning they were statistically significant. As a result, COVID-19 has a detrimental impact on the characteristics of the sperm, including the sperm DNA fragmentation index. Conclusion(s): The quality of the semen remained low up until the second time it was sampled, despite the fact that we were unable to discover SARS-CoV-2 in the sample. It is recommended that assisted reproductive technology (ART) clinics and sperm banking facilities evaluate the quality of the sperm produced by males infected with COVID-19 and exclude men who have a history of being infected with SARS-CoV-2 until the men's sperm quality recovers to normal. Copyright © 2023 Ubiquity Press. All rights reserved.
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Background: Higher thrombotic risk associated with non-O blood group individuals is observed especially when in combination with thrombophilia. Aim(s): To estimate the association of ABO blood type with venous thromboembolism (VTE). Method(s): In this retrospective case control study we enrolled 40 patients with confirmed VTE. In all of them ABO blood group was determined using serologic methods such as column agglutination technique which included forward and reverse typing. Thrombophilia testing was performed in 12 patients with unprovoked VTE event. Result(s): ABO distribution among VTE patients is as follows: A in 19 (47.5%), O in 5 (12.5%), B in 10 (25.0%) and AB in 6 (15.0%) patients. The prevalence of O blood group in VTE patients was significantly lower (12.5%) in comparison to non-O blood types (87.5%). Blood group A is more prevalent and group O is less prevalent in VTE patients in comparison to our general population in which the frequency of A and O blood group is 41% and 32% respectively. In 6 VTE patients Covid 19 was confirmed few weeks prior to the thrombotic event (4-A, 1-O and 1-B blood group). In 12 patients tested for thrombophilia, 36 mutations were discovered with the following frequency: FII G20210A-5.5%, FVL G1691A-13.8%, FXIII V34L-8.3%, FGB G455A-11.1%, ITGA2 C807T-5.5%, ITG B3 T1565C-2.7%, PAI-1 4G/5G675-27.7%, MTHFR C677T-25%, from which 24 were heterozygous and 12 were homozygous (2-FVL, 2-FXIII, 1-FGB, 6-PAI- 1 and 1 case with MTHFR mutation). All of the patients have more than one mutation in different combinations and their ABO distribution was similar as in the rest of the VTE patients. Conclusion(s): According to the results, individuals with non-O blood group are more prone to VTE. ABO phenotype and especially ABO genotype may be additional diagnostic tool for assessment of the VTE risk together with thrombophilia markers.
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Background: Patients (Pts) with hematologic malignancies (HM) are at greater risk of severe morbidity and mortality caused by COVID19 and show a lower response to the two-dose COVID19 mRNA vaccine series. The primary vaccine series now includes a third dose of the COVID19 vaccine (3V) for immunocompromised Pts. The objective of this study was to explore the characteristics of HM patients who had no change in SARS-CoV-2 spike protein titer levels post 3V (-/-) to gain a better understanding of the drivers of serostatus. Methods: This retrospective cohort study analyzed Pt data on SARS-CoV-2 spike IgG antibody titers pre- and post- 3V across the healthcare system. This study included 268 fully vaccinated HM Pts diagnosed with HM between October 31, 2019 and January 31, 2022 and had a negative serostatus prior to 3V. Post 3V titers were obtained 21 days after 3V. Demographics, association between characteristics and seroconversion status, and odds ratios were all assessed (table). Results: Pts with Non-Hodgkin lymphoma (NHL) had 6 times the odds of not seroconverting compared to multiple myeloma (MM) (CI 1.88 - 19.12, P = .0010). NHL also have about 14 times the odds of not seroconverting compared to Pts diagnosed with other HM conditions, which included: neoplasms of uncertain behavior and disorders of white blood cells (CI 1.72 - 112.44, P = .0021). 90% of seronegative Pts showed no spike IgG antibody reaction to 3V as indicated by pre- and post- 3V index values. Demographics, previous COVID19 infection, and vaccine type were not significantly associated with seroconversion. Conclusions: HM patients who are not seroconverting after 3V, suggest a prioritized population for continued increased behavioral precautions, additional vaccination efforts, including a fourth dose of an mRNA COVID19 vaccine, as well as passive immunity boosting through monoclonal and polyclonal antibodies.
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A 48 y.o. male maintenance worker in a rat-infested building with history of tobacco and marijuana smoking, atrial fibrillation on no medications was admitted in July 2021 for fever, headache and body aches for 5 days and new onset of hemoptysis. Initial labs notable for BUN 36 mg/dl, Cr 1.4 mg/dl urine protein 100 mg/dl RBCs 5-10/hpf, platelets 46,000. total bilirubin 3.8 mg/dl direct bilirubin 3.0 SARS-CoV-PCR negative and CXR revealed patchy bilateral infiltrates. He was intubated on day 2 and had ventricular fibrillation and cardiac arrest on day 3 with rapid return of purposeful movement. He had worsening anemia and thrombocytopenia, positive ANA and dsDNA, leading to use of steroids and plasmapheresis on Day 6 when peak bun/cr was 91/3.1 with urine protein/cr ratio 0.7, urine microscopy 2 rbc/hpf, urine Na 20 meq/l, urine osm 775 mosm/kg and cpk 400 U/l. These tests were negative or normal: Anti-GBM, ANCA, repeat ANA, repeat dsDNA, C3, C4, HIV, RF, hepatitis C RNA, cryoglobulins, ASO titer, ADAMTS13, Pneumocystis PCR, Sputum AFB, blood, AFB and fungal cultures, viral and fungal testing, hanta virus antibodies. Leptospira antibodies IgM by Dot Blot were positive and Leptospirosis diagnosis confirmed by NYC Department of Health (DOH) after obtaining confirmatory microscopic agglutination testing from the CDC. Urine and blood Leptospira DNA PCR not detected. He remained intubated with FiO2 requirement at 100% prior to his death on hospital day 16. Initially pulmonary renal syndrome considered but he was later found to have pre-renal azotemia. The elevated bilirubin led to testing for leptospirosis, his final diagnosis. In September 2021 the NYC DOH reported 14 cases of leptospirosis (increased from 5 cases in 2020), 13 of which had acute renal and hepatic failure, with 2 having severe lung involvement (1). This case is the only one in this group who died. The leptospirosis case fatality rate for severe diffuse alveolar hemorrhage exceeds 50%. Early appropriate antibiotic treatment prior to lab confirmation has been recommended by the CDC and may decrease severity of disease.
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Background: Adverse perinatal outcomes in patients with novel coronavirus infection (COVID-19) have been described in isolated cases. The ongoing effect of the virus on the body necessitates the accumulation of information on the causes of complications during the gestation period, especially in mild and moderate disease forms that do not lead to severe respiratory and multiple organ failure, which is important for managing pregnancy and developing measures to prevent adverse perinatal outcomes in patients with COVID-19. Case report: The paper describes 2 cases of antenatal fetal death in pregnant patients with mild and moderate COVID-19 and a familial history of non-developing pregnancies that occurred in the third wave of the epidemic process. One patient was recorded to have antenatal fetal death that occurred at 37–38 weeks’ gestation with a birth weight of 2670 g and the other patient had that at 23–24 weeks’ gestation with a birth weight of 520 g in the late stages of the disease (days 9 and 13, respectively). These patients are described to have placental morphological alterations;there was a preponderance of the signs of severe maternal vascular malperfusion as thrombosis in the intervillous space with massive fibrin deposits;large hematomas and infarcts, extensive numerous areas of fibrinoid villous agglutination and an inflammatory reaction. At the same time, the standard methods were used to detect viral RNA in the tissues of the placenta, fetal lungs, and maternal nasopharynx. Conclusion: The analysis of each antenatal fetal death case in pregnant patients with COVID-19 is the basis for the formation of recommendations for the prevention of perinatal complications.
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The purpose of this study was to assess how skin biopsy results from adults, which occupy an important place in dermatological practice, have been affected by the COVID-19 pandemic. Adult patients aged over 18 presenting to the dermatology clinical of a tertiary hospital between March 12, 2019 and March 11, 2020, and between March 12, 2020 and March 11, 2021, from whom skin biopsies had been taken and who had undergone pathological examination were included in the study. Pre-COVID-19 pandemic data were compared with post-pandemic data. No significant difference was determined between the two periods in terms of age, sex, type of biopsy, preliminary diagnosis numbers, or clinicopathological correlation (P>0.05). The diseases most frequently diagnosed through biopsy before the pandemic were psoriasis (13.7%), pseudopelade of Brocq (6.8%), and fibroepithelial polyp (5.5%), compared with psoriasis (9.4%), basal cell carcinoma (BCC) (6.3%), lichen planus (6.3%), and urticarial vasculitis (6.3%) during the pandemic. Diagnoses of BCC and urticarial vasculitis were significantly elevated after the COVID-19 pandemic (P<0.05), while no periodic difference was observed in other diagnoses. A rise in the incidence of various diseases, such as urticarial vasculitis, may be indicative of a risk of asymptomatic COVID-19. Further polymerase chain reaction and/or antibody-based investigations should be carried out in order to establish whether dermatological diseases are associated with asymptomatic COVID-19 cases. Determining the clinical and histopathological aspects of COVID-19, which can progress with various cutaneous findings, will be useful in the early diagnosis and treatment of this novel and life-threatening disease.
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Objective: To explore the underlying reasons of dizziness experienced by patients after having the COVID-19 infections or vaccinations. Background: At our dizziness center, we saw a spike of dizziness consults after patients were diagnosed with COVID-19 infections or received COVID-19 vaccinations. The symptoms included dizziness, vertigo, and imbalance. This study aims to examine if the infection, vaccination, or antibodies from such could be the reason for the dizziness complaints or if other factors explain patients' dizziness. Design/Methods: Patients were identified using a combination of retrospective chart review to identify patients with diagnoses of dizziness, COVID-19, and COVID-19 vaccinations from our database, coupled with referrals from ongoing clinical consultations who we believed to exhibit dizziness symptoms related to their COVID-19 infections or vaccinations within four weeks of dizziness onset. Patients all had brain MRI and extensive vestibular testing, including: VNG, Rotary Chair, audiograms, and consultation with an experienced neuro-otologist. Results: Of the 40 patients examined, 20 began experiencing dizziness after testing positive for COVID-19 and 20 reported dizziness after receiving the vaccines. All patients had brain MRI, but no MRI findings indicated inflammatory changes from infections or antibody reactions. Only five of 40 patients had abnormal VNG indications of uncompensated peripheral vestibulopathy which could be related to virus infections or antibody reactions. Thirty out of 40 patients had histories of anxiety, depression, other mood disorders, or family histories of mood disorders. Based on the clinical history and examinations, along with MRI findings and comprehensive vestibular testing, 75% of the 40 patients had diagnoses of persistent perceptual positional vertigo (PPPV), which was most likely related to patients' underlying anxiety, depression, or mood disorders. Conclusions: We believe that the COVID-19 infections or vaccinations may trigger PPPV as stressors, but mostly not due to the virus infections or its antibody reactions.
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Background: Anti-P1 is a common antibody found in the sera of P2 donors, affecting one-quarter to two-thirds of those tested. Anti-P1 is an IgM isotype antibody that is frequently found as a weak cold agglutinin. Anti-P1 antibodies that are reactive at 37 Celsius or cause in vitro hemolysis are rare. With the exception of the rare Bombay phenotype, all red cells express the H antigen. The amount of H antigen on red cells is determined by an individual's ABO type since H antigen is the precursor to both A and B antigens. The expression of the H antigen is highest in group O and lowest in group A1B (O>A2 > B > A2B > A1 > A1B). We report a case of blood discrepancy mimicking Para-Bombay due to anti-P1 and weak H antigen expression in a 46-year-old Sarawak Malay blood donor during routine blood donor regrouping with an automated immunohematology analyser. She has history of COVID19 infection in September 2021 and she completed her 1st, 2nd and booster mRNA vaccine in November 2021. Her last pregnancy was 13 years ago, and she has no history of blood transfusions. Aims: To resolve blood group discrepancies detected when using an automated immunohematology analyser. To understand the possibility of interference from natural occurring cold-reacting red cell alloantibodies during indirect antiglobulin test blood grouping. To understand the possibility of false negative in forward grouping with anti-H antisera in donors with A1B blood group. Methods: Blood donor was typed for ABO and Rh by an automated immunohematology analyser with microplates. Serological methods for antibody detection and specification were done manually with column agglutination method (gel-card) and tube method. Results: Forward grouping of the donor's first sample with an automated analyser was strongly positive for Anti-A (4+), Anti-B (4+), Anti-AB (4+) and Anti-D (4+), while reverse grouping was also strongly positive for A1-cell (3+), B-cell (3+) and O-cell (4+). Manual serological methods with gel-card and tube method yielded similar results. Anti-H showed no reaction. The first sample was negative for Direct Coomb's test (DCT). The donor's second (repeat) sample using the manual serological method yielded similar results;however, reverse grouping repeated at 37 Celcius resulted in the cessation of reactions on known cells. Anti-H showed a 1+ reaction. Antibody screening was positive and proceeded to 11 panel antibody identification with Anti-P1 identified. DCT was negative in the second sample. (P1-) and Le(a-b+) are her phenotypes. Summary/Conclusions: Anti-P1 is commonly reported as cold reacting alloantibody in patients. In this case, a combination of strong reacting anti-P1 at room temperature and commonly low H antigen volume in A1B red cells lead to a false initial suggestion of Para- Bombay phenotype. Blood grouping discrepancies detected with automation should always be repeated manually.
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Background: ABO hemolytic disease of the fetus and newborn (ABOHFDN) is a frequent event, and usually a problem of the neonate rather than the fetus, however, it is difficult to predict the disease severity. Thus, there is a need to increase awareness towards ABOHFDN for optimizing care in terms of early diagnosis and adequate monitoring. Aims: To determine the frequency of ABO-incompatibility in neonates born to group O mothers and to assess the severity of ABO-HDFN in neonates and determine the neonatal outcomes. Methods: This prospective observational study was carried out from February 2020 to May 2021 after obtaining a written informed consent from the mothers. A total of 260 neonates born to blood group O mothers were recruited. The maternal red cell antibody screen (ABS) using a 3-cell panel (Diacell, Bio-Rad, Switzerland) and the neonatal direct antiglobulin test (DAT) were done by column agglutination technique (CAT). For DAT positive samples, the IgG subclass of anti-A/anti-B was determined using DAT IgG1/IgG3 screening cards (Bio-Rad, Switzerland) and a heat elution at 56°C was also performed. The maternal anti-A/anti-B IgG titers was determined by tube technique after treating the serum sample with 0.01 M di-thiothreitol (DTT). The neonatal total serum bilirubin (TSB) and other relevant parameters were also recorded. The requirement for treatment in terms of phototherapy and/or exchange transfusion (ET) and the neonatal outcome were also recorded. Due to travel restrictions during the ongoing COVID-19 pandemic, the follow-up was performed telephonically with parents 6-8 weeks after discharge. Results: Of the 260 group O mothers, none had positive ABS. Of the 260 neonates born to them as an outcome of singleton pregnancies, 84 with blood group O were excluded from the study. The overall frequency of ABO-incompatibility between mother and neonates was 67.69% (176/260). Out of 176 neonates, 77 (43.8%) were group A and 99 (56.2%) were group B, and 15 (8.5%) of them had a positive DAT. Overall, 26.7% (47/176) neonates received phototherapy and 172 (97.7%) neonates survived. The mean (±SD) duration of phototherapy (hours) was 34.17 (±25.67) hours and it ranged from 12- 120 h. Only 1 neonate required ET. None of the neonates required readmission. The median maternal IgG anti-A titre was 16 (8-64) (range: 2-512), while the IgG anti-B titre was 32 (32-64) (range: 4- 512) (p = <0.001). The maximal TSB in neonates had a significant positive association with neonatal birth weight (p = 0.045), maturity at birth (p = 0.037), positive DAT (p = 0.006) and requirement of phototherapy (p = <0.001). Neonatal DAT positivity was significantly associated with maternal IgG titers (p = <0.001), neonatal PCV (p = 0.017), maximal TSB (p = 0.006), requirement (p = <0.001) and duration of phototherapy (p = 0.024). At a cut-off of maternal IgG titre ≥64, it predicted the requirement of phototherapy with a sensitivity of 72.3% and a specificity of 72%. The relative risk (95% CI) of a DAT positive neonate requiring phototherapy was calculated to be 4.55 (3.12-6.33). Summary/Conclusions: The frequency of ABO-incompatibility in neonates born to group O mothers was 67.69% (176/260). The maternal IgG titre of anti-A/anti-B of 64 or more could be a good predictor for identifying the neonates at-risk for developing hyperbilirubinemia requiring further management and combining it with neonatal DAT further enhances the sensitivity to identify such at-risk neonates.
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Background: The pandemic of COVID-19 has led to alterations in SOP across the transfusion process, including administration of blood in COVID-19 wards. COVID-19 patients who present with symptomatic anaemia and have multiple risk factors will need blood transfusions. ABO-incompatible blood transfusions leading to acute haemolytic transfusion reaction is a rare but potentially fatal complication. The National Haemovigilance Coordinating Centre of the National Blood Centre, Malaysia reported the national incidence of incorrect blood components transfused (IBCT) in relation to total blood products transfused in 2019 to be 75 per 10,000 units. Five IBCTs reported were related to administration errors. Aims: We reported two IBCTs involving two patients who required blood transfusions in a COVID-19 ward. Patient 1 was a 74 year old man who complained of chest pain, with a haemoglobin (Hb) of 5.7 g/ dl. Patient 2 was a 50 year old woman with a Hb of 6.4 g/dl. When the two units of blood arrived on the ward, one doctor completed the pre-administration checklist in the 'clean' zone, which Nurse 1 then counter-checked. Nurse 1 put the two blood bags into separate transparent plastic bags and labelled them with the wrong patient's identity sticker. She then handed both blood bags to Nurse 2 in the 'dirty' zone, without the patients' blood compatibility labels, blood request forms and bedside checklist forms. Positive patient identification was not done by Nurse 2 and the transfusions commenced. Patient 1 complained of chills around 10 min into the transfusion. The error was only realized 35 min into the transfusion when the symptoms persisted and the temperature taken was 38°C. Patient 2, who was given a unit of group O blood that belonged to Patient 1, did not report any adverse reactions. Our aim is to identify the root causes of these IBCTs and to execute the necessary changes in pre-transfusion SOP to minimize future recurrences. Methods: Samples from both patients were investigated for transfusion reactions. Rechecking of blood groups was done manually with the test tube method. Direct and indirect anti human globulin tests (DAT/IAT) and recheck of cross-matching were performed with the column agglutination technology (CAT) method at 37/AHG phase. Urine samples were tested using urine dipsticks. Isohaemagglutinin (anti-A/B titre) was performed using the CAT method at 37/AHG phase. Plasma Hb was measured with a photometer and a microcuvette. Results: Both patient 1's post-transfusion samples (immediate and post-24 h) were O-RhD positive. Blood group of the donor's bag was B-RhD positive. DAT for both samples was positive with IgG(3+) and C3D (1+). IAT for both samples was negative. Recheck of crossmatching with both samples was incompatible (4+). Urine tests were negative for haemoglobin. A low anti-B titre of 1:16 was detected. Plasma Hb was measured twice at a low level below the reference range. Patient 2's workup was unremarkable. Summary/Conclusions: Two IBCTs occurred in the COVID-19 ward, with one major ABO-mismatched IBCT due to human errors and deviation from standard SOP. Pre-transfusion SOP was still unclear in the COVID-19 ward setting prior to these incidences. All medical personnel in the COVID-19 ward underwent retraining on safe transfusion practices. One COVID-19 patient's blood compatibility label, blood request form, bedside checklist form and blood bag should be brought into 'dirty' zone to be checked by two medical personnel at one time.
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Background: A positive direct antiglobulin test (DAT) is frequently observed for patients suffering from COVID-19 but its interpretation in transfusion dependent patients such as patients with solid and haematological malignancies is complex and multi-factorial. Aims: • To identify the incidence of DAT positivity in cancer patients hospitalized with COVID-19. • To explore the significance of DAT positivity in those patients by comparing with the DAT-negative COVID-19 patients (control group). Methods: This was a cross-sectional study done in India where samples were obtained from 88 cancer patients with confirmed COVID- 19. All patients were hospitalized. No patient had received COVID-19 convalescent plasm. IAT was negative in all patients. DAT was performed using column agglutination technology, and samples that were DAT positive were further investigated using monospecific DAT facility. If the strength of DAT was 2+ or above with IgG then the elution was performed with an elution kit. The eluates were then tested with a commercial three-cell panel of RBCs to establish whether the IgG antibodies had any RBC antigen specificity. In case the DAT was positive for C3d, the cold agglutination titre was estimated. A chi-square test was used for discrete variables, and a student t-test or a Wilcoxon-Mann-Whitney test was used with p-values below 0.05 considered as significant. Results: There was no significant difference between the patients with positive DAT and patients with negative DAT (Table 1). DAT was positive in 32 of 88 (36.36%) patients. Of the 32 cases, 28 (87.5%) were positive for IgG only, one (3.13%) was positive for both IgG and complement, and three (9.38%) were positive for C3d.More than 2+ agglutination was seen in 6 (18.8%) patients. Out for those six cases two were positive for C3d only (4+) with a cold agglutination titre of 2048. None of the eluted samples in rest of the four cases with IgG reactivity showed specificity for RBC antigens in the three-cell panel. Total bilirubin and LDH values were not different between two groups which suggest that the anaemia in DAT-positive group was not due to haemolysis rather it could be associated with severity of disease. The increase morality that was observed in DAT-positive group might be explained similarly. Summary/Conclusions: Results of this study show that a high percentage of cancer patients with COVID-19 are DAT positive, but majority of these patients do not have any evidence of haemolysis and do not require more blood transfusion compared to others. The clinical implications of this high DAT positivity in COVID-19 patients need further exploration. (Table Presented).
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Coronavirus disease 2019 (COVID-19) is caused by pathogenic and highly transmissible Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is a single stranded RNA virus. It rapidly emerged from an epidemic to a global pandemic form spreading in alarming levels. The pathogenesis involving spike protein which is present on the viral surface, plays a key role in host attachment and penetration. SARS-CoV-2 infection significantly affects respiratory system, but may involve other systems including haematopoietic system and homeostasis. Aim of the review article is to discuss spectrum of haematological changes in the blood counts, coagulation, peripheral blood and bone marrow in COVID-19 for complete understanding the disease process, the knowledge of which is helpful in early diagnosis and management of these patients. An extensive immune profiling of B and T cell population with analysis of spectrum of immune changes during the period of infection were also discussed. In COVID-19, changes in laboratory parameters and hematologic abnormalities have been reported and its association with early diagnosis, disease prognosis and severity has been repeatedly discussed in the literature. Changes in laboratory investigations help in risk stratification and early intervention. The most common laboratory finding in COVID-19 is lymphopenia. COVID-19 patients presented with coagulopathy is at high risk of morbidity and mortality. In severe COVID-19 patients, bone marrow aspirate shows histiocytic proliferation with hemophagocytosis. To understand the correlations between immune responses and severity of COVID-19, immune profiling of B and T cell population was compared with extensive clinical data. A deep understanding of the laboratory findings and haematological abnormalities associated with SARS-CoV-2 infection would help to raise disease suspicion in absence of Real time polymerase chain reaction or antibody results. Also the blood counts along with the morphological changes in peripheral blood would be helpful in prompt screening, diagnosis, prognosis and management of COVID-19 patients.
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Introduction: Infection with SARS CoV2 leads to respiratory failureand can lead to support of extracorporeal oxygenation (ECMO)leading to exposure to heparin. Exposure to heparin and developmentof thrombocytopenia raises the suspicion of HIT. The strong positiveIgG PF4-heparin antigen test by immunochromatography is followedby platelet aggregation test in our center. We present a case of covid-19 in which HIT was strongly positive on gel agglutination butfunctional assay was negative. Review of literature shows that this could be due to circulating platelet immune complexes in critically illcovid patients which simulate HIT antibodies.Aims &Objectives: Materials &Methods: 7 months pregnantfemale, non-vaccinated, asthmatic, COVID 19 positive patient wasadmitted to our hospital. On admission her fetal ultrasound wasnormal and was started on non-invasive ventilation along with supportive care. However she deteriorated and shifted to veno-arterialextracorporeal membrane oxygenation support (ECMO). Her plateletcount dropped by>50% at day 6 of heparin exposure with anintermediate probability for HIT (4Tscore 5). HIT gel agglutinationtest was positive for IgG antibodies for antiheparin/PF4 antibodies butfunctional assay based on heparin-induced platelet aggregation(HIPA) revealed no increase in aggregation of patient serum with0.5U/ml and 1U/ml heparin dosage. Heparin induced thrombocytopenia was ruled out due to PAT and patient continued on ECMO.This could be due to increased platelet activating immune complexesor anti-PF4 antibodies mimicking antiheparin/PF4 antibodies. However, patient deteriorated and succumbed to the disease.Result: Heparin induced thrombocytopenia was ruled out due to PATand patient continued on ECMO. This could be due to increasedplatelet activating immune complexes or anti-PF4 antibodies mimicking antiheparin/PF4 antibodies. However, patient deteriorated andsuccumbed to the disease.Conclusions: Pathophysiology of Covid 19 disease in critical caseshas shown exacerbated immune reactions, increased endothelialinjury, which causes increased release of PF4 leading to plateletactivation.3 A recent work has also shown significantly increasedplatelet apoptosis, secondary to IgG-mediated FccRIIA signaling, incritically ill COVID-19 patients.4 It is also possible that the circulating immune complexes may be formed by corona virus-antibodycomplexes (as seen in H1N1 viral infection) 0.5 A high titre of antiPF4/heparin antibody test may not strongly predict the presence ofclinically relevant HIT antibodies, thus a confirmatory functional testshould be performed.
ABSTRACT
Background: COVID-19 antibodies' longevity following infection is still unclear. Early data brought hope that acquired immunity was possible1 but subsequent studies suggested that immune protection might be short-lived. The results of recent studies provide greater insight into the human immune response to COVID-192,3. The Qatar Gas medical department's strategy in preventing spread of infection among offshore and onshore workers consisted of maximizing the opportunities for COVID-19 polymerise chain reaction (PCR) and antibody testing. A large amount of data revealing the possible lifespan of COVID-19 antibodies in the study population was collected. Methods: Out of hundreds of employees who volunteered in this study about seroprevalance of COVID-19 antibodies, 52 whose results were reactive were tested for COVID-19 PCR before being selected. Employees with reactive or inconclusive PCR test results were excluded. Age, medical/surgical/social history, apart from past COVID-19 infection, were not selection criteria. We measured the period of time between the date of diagnosis and the antibody test result, segregating those still reactive from those who tested non-reactive at any point in time. The reactive group were retested for antibodies every 90 days as long as results continued to be reactive. Any cured employee was retested if they developed symptoms or was exposed to a confirmed positive case, to rule out the possibility of re-infection during this timeframe. Results: Only one employee was non-reactive after 110 days of COVID-19 PCR positive test result. 22 employees tested reactive although their PCR result had been negative. 30 employees tested reactive after a positive PCR with an average duration of 145 days, the shortest and longest being 24 and 223 respectively (Figure 1). Conclusion: We determined that antibodies' longevity may extend to more than 6 months following COVID-19 infection and that there may be an early decay of antibodies in a limited proportion of the population, however further studies are recommended on larger populations. We noticed no cases of COVID-19 reinfection.