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2.
Transfus Med ; 27 Suppl 5: 369-374, 2017 Oct.
Article in English | MEDLINE | ID: mdl-28393455

ABSTRACT

BACKGROUND: HLAMatchmaker has been used in the Irish Blood Transfusion Service (IBTS) to select platelets for HLA-alloimmunised, platelet refractory thrombocytopaenic patients since 2006. Although available since 2002, only three studies have been published supporting the programme's effectiveness for this indication. OBJECTIVES: We sought to examine increments to HLA-matched platelets (HMPs) at various matchmaker scores and to examine the impact of transfusing older platelets and ABO-mismatched platelets to this patient group. METHODS/MATERIALS: A total of 20 consecutive HLA-alloimmunised thrombocytopaenic patients were retrospectively studied. Data collected included: pre- and post-transfusion platelet count, indication for transfusion, HLAMatchmaker score, age of unit and degree of ABO mismatch. Data were also collected on the last 3 U of (RDPs). The Mann-Whitney U-test was used to compare increments between transfusion episodes of random donor platelets (RDPs) vs HMPs with matchmaker scores <3, 4-7 or >8. RESULTS: Increments at <2 h were available for 63 transfusion episodes. Increments at 2-24 h were available for 93 transfusion episodes. Increments were higher when transfusing HMPs than when transfusing RDPs. Increments for HMPs that were ABO mismatched were no different than for ABO-identical units, with the exception of late increments post-transfusing HMPs with a major ABO mismatch. Age of platelets did not influence increments. CONCLUSION: The use of HLAMatchmaker to select platelet units for thrombocytopaenic HLA-alloimmunised patients produced satisfactory platelet increments. When providing HLAMatchmaker-selected HMPs, ABO mismatch and the use of platelet units that are up to 7 days old should be permissible.


Subject(s)
Blood Donors , Blood Platelets/immunology , Histocompatibility Testing , Platelet Transfusion , Thrombocytopenia , ABO Blood-Group System/immunology , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Platelet Transfusion/adverse effects , Platelet Transfusion/methods , Retrospective Studies , Thrombocytopenia/etiology , Thrombocytopenia/immunology , Thrombocytopenia/therapy
3.
Transfus Med ; 27(1): 66-71, 2017 Feb.
Article in English | MEDLINE | ID: mdl-27714877

ABSTRACT

BACKGROUND: Real-world studies of the emergency reversal of warfarin using 4-factor prothrombin complex concentrate (PCC) report unwarranted delays. The delay to receiving PCC was ≥ 8 h in 46·7% of patients with warfarin-associated bleeding (PWAB) treated with a variable PCC dosing protocol in our retrospective audit. OBJECTIVE: To report the impact of a simplified PCC dosing protocol on the interval to reversal of anticoagulation. METHODS: We developed a PCC dosing protocol standardising the initial PCC dose and simplifying dosing calculations. Study end points were the proportion of PWAB achieving international normalised ratio (INR) ≤1·5 and treated within 8 h of presentation, respectively. RESULTS: Of 17, 15 (88·2%) PWABs achieved a post-treatment INR ≤ 1·5; 14 of 17 (82·4%) PWABs were reversed within 8 h. Median intervals between triage and PCC request and PCC request and start of infusion (administration interval) were 126 min (range 39-520) and 30 min (range 5-100), respectively. Compared with the retrospective cohort, RAPID is associated with an improved administration interval (mean 37·7 vs 76 min, P = 0·031) and the proportion of PWABs treated within 30 min (58·8 vs 6·7%, P = 0·009). CONCLUSION: The RAPID protocol reduces unwarranted delays without compromising efficacy.


Subject(s)
Blood Coagulation Factors/administration & dosage , Blood Coagulation Factors/pharmacokinetics , International Normalized Ratio , Warfarin/adverse effects , Adult , Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Retrospective Studies , Time Factors , Warfarin/administration & dosage , Warfarin/pharmacokinetics
5.
Ann Hematol ; 85(7): 455-7, 2006 Jul.
Article in English | MEDLINE | ID: mdl-16568320

ABSTRACT

Raised percentage hypochromic red cells (%HRC) were detected at diagnosis in 10 of 34 consecutive patients with low-risk myelodysplastic syndrome (MDS) [refractory anemia (RA) (4/26) and RA with ring sideroblasts (6/8)], all of whom had normal or increased serum ferritin and bone marrow iron stores. Elevated %HRC has persisted in all 10 cases and subsequently developed in another RA patient who later had a complete remission of MDS with normalisation of %HRC after a respiratory tract infection. A strong positive correlation was found between %HRC and erythrocyte zinc protoporphyrin levels in 11 MDS patients tested (p=0.01), suggesting that functional iron deficiency contributes to ineffective erythropoiesis in cases of MDS with raised %HRC. Five of seven patients with elevated %HRC had satisfactory haemoglobin responses to a trial of human recombinant erythropoietin without iron supplementation.


Subject(s)
Anemia, Hypochromic/epidemiology , Anemia, Iron-Deficiency/epidemiology , Myelodysplastic Syndromes/blood , Anemia, Iron-Deficiency/blood , Blood Cell Count , C-Reactive Protein/analysis , Ferritins/blood , Humans , Iron/blood , L-Lactate Dehydrogenase/blood , Prevalence , Transferrin/metabolism
6.
Eur J Haematol ; 76(3): 258-60, 2006 Mar.
Article in English | MEDLINE | ID: mdl-16451399

ABSTRACT

Secondary or late graft failure has been defined as the development of inadequate marrow function after initial engraftment has been achieved. We describe a case of profound marrow aplasia occurring 13 years after sibling allogeneic bone marrow transplantation for chronic myeloid leukaemia (CML) in first chronic phase. Although the patient remained a complete donor chimera, thereby suggesting that an unselected infusion of donor peripheral blood stem cells (PBSC) or bone marrow might be indicated, the newly acquired aplasia was thought to be immune in aetiology and some immunosuppression was therefore considered appropriate. Rapid haematological recovery was achieved after the infusion of unselected PBSC from the original donor following conditioning with anti-thymocyte globulin (ATG).


Subject(s)
Bone Marrow Diseases/etiology , Bone Marrow Transplantation/adverse effects , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/complications , Antilymphocyte Serum/therapeutic use , Bone Marrow Diseases/drug therapy , Bone Marrow Diseases/pathology , Bone Marrow Transplantation/methods , Female , Histocompatibility Testing , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive/therapy , Middle Aged , Peripheral Blood Stem Cell Transplantation , Siblings , Transplantation, Homologous , Treatment Outcome
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