British Committee Research Articles

Response to Single Agent Cyclosporin in Patients with Non-Severe Aplastic Anaemia.

To determine the effectiveness of cyclosporin A (CSA) monotherapy in treating patients with non-severe aplastic anaemia (NSAA). A cross-sectional observational study. Place and Duration of the Study: Department of Clinical Haematology, Armed Forces Bone Marrow Transplant Center, Rawalpindi, Pakistan, from January 2022 till December 2023. A total of 51 patients of NSAA, classified as aplastic anaemia not satisfying criteria for severe and very severe disease as per Modified Camitta Criteria, were included. Results were evaluated in terms of survival rate (OS) and responses. Responses were assessed as complete response (CR), partial response (PR), overall response (ORR), and no response (NR) by using standard British Committee for standard Haematology (BCSH) response criteria at 3, 6, and 12 months. Out of 51 patients, 34 (67%) were males and 17 (33%) were females. Median age at the time of diagnosis was 25 (IQR 26) years. At follow-up of 12 months, OS was 86.3%. Overall response rates to cyclosporin monotherapy at 3, 6, and 12 months were 49%, 57%, and 59%, respectively. Baseline haemoglobin was associated with responses at 6 and 12 months and a significant association was found between transfusion dependency at 3, 6, and 12 months with overall survival (p = 0.01, 0.005, and 0.04, respectively). Responses at time-defined points also had significant impact on OS (3 months Plog-rank = 0.046, 6 months Plog-rank = 0.01, and 12 months Plog-rank = 0.008). Overall response rates at 3, 6, and 12 months indicate the potential of CSA as a viable treatment option, particularly in resource-constrained settings. Despite some patients experiencing treatment-related complications, CSA demonstrated a generally tolerable safety profile. Cyclosporin A, Non-severe aplastic anaemia, Survival rate, Response rate, Complete response, Partial response.

Three Stages in the Evolution of the Concept of International Society: The History of the English School of International Relations or the History of Academic Communities?

This article considers the development of the English school of international relations. The enduring influence of its central concept pursued by international society on three generations of scholars is examined. Three stages are identified in the evolution of the above concept. In the first stage, the British Committee for the Study of International Politics laid the groundwork for the subsequent genesis of the school’s concept. In 1970, H. Bull formulated its basic tenets. The second stage is associated with the efforts to attract more researchers to the school in order to expand the scope of the concept and introduce new problems to the field. As a result, the school transformed from a rather closed group of researchers into a diverse community of specialists in international relations. During the third stage, this community divided over the assessment of modern international society, which not only caused a rift within the school but also prompted a modernization of its concept in line with the most recent theoretical insights into the nature of international relations. Therefore, the history of the English school of international relations was underpinned by the collective work of various research groups united under the broad methodological frameworks of the concept supported by international society.

Antiphospholipid Syndrome and Lupus Anticoagulant: Where do we stand today ?

Antiphospholipid Syndrome and Lupus Anticoagulant: Where do we stand today ?

Prevention and treatment of infection in patients with an absent or hypofunctional spleen: A British Society for Haematology guideline.

Guidelines for the prevention and treatment of infection in patients with an absent or dysfunctional spleen were published by the British Committee for Standards in Haematology in 1996 and updated in 2002 and 2011. With advances in vaccinations and changes in patterns of infection, the guidelines required updating. Key aspects included in this guideline are the identification of patients at risk of infection, patient education and information and immunisation schedules. This guideline does not address the non-infective complications of splenectomy or functional hyposplenism (FH). This replaces previous guidelines and significantly revises the recommendations related to immunisation. Patients at risk include those who have undergone surgical removal of the spleen, including partial splenectomy and splenic embolisation, and those with medical conditions that predispose to FH. Immunisations should include those against Streptococcus pneumoniae (pneumococcus), Neisseria meningitidis (meningococcus) and influenza. Haemophilus influenzae type b (Hib) is part of the infant immunisation schedule and is no longer required for older hyposplenic patients. Treatment of suspected or proven infections should be based on local protocols and consider relevant anti-microbial resistance patterns. The education of patients and their medical practitioners is essential, particularly in relation to the risk of serious infection and its prevention. Further research is required to establish the effectiveness of vaccinations in hyposplenic patients; infective episodes should be regularly audited. There is no single group ideally placed to conduct audits into complications arising from hyposplenism, highlighting a need for a national registry, as has proved very successful in Australia or alternatively, the establishment of appropriate multidisciplinary networks.

Optimising platelet usage during the induction therapy of acute myeloid leukaemia: Impact of physician education.

Platelet products are scarce and expensive resources to be used judiciously. However, inappropriate usage is common. Lack of physician awareness is an important issue. We implemented a physician education program (PEP) along with repeated WhatsApp reminders at our centre. We audited the platelet usage practise before and after the intervention. Charts of patients with acute myeloid leukaemia (AML) treated between January 2020 and August 2020 was reviewed, and the mean platelet usage per patient per day was calculated. Physician education was implemented between September 2020 and December 2020 (2 PowerPoint lectures of 20 min each and weekly WhatsApp messages containing the guidelines). Data of patientstreated between Jan 2021 and August 2021 was prospectively audited to understand platelet usage and the indications for transfusions. The British Committee for the Standards in Haematology (BCSH) platelet transfusion guidelines were used as the adjudication tool to evaluate compliance. The mean platelet usage per day per kg body weight of a patient before and after the PEP was compared using the t-test. Group A (before physician education) consisted of 22 patients, and group B (after physician education) consisted of 23 patients. The mean number of platelet transfusions for each patient in a day per kg body weight was 125.7 × 108 in group A whereas, after the PEP, it had reduced to 73.9 × 108 amounting to an absolute reduction of 51 × 108 (58.8%) from the baseline with a statistical significance of P=0.001. After implementing the PEP, the mean number of random donor platelets used reduced by 10.25 units (34% reduction), and the mean single donor platelets used reduced by 0.83 units (19% reduction). The 190 requests for platelet transfusion received during this period were classified as appropriate (157/190), which constituted 82.63% of the requests, or inappropriate (33/190), which accounted for 17.36%. A short-duration education programme supplemented with weekly WhatsApp messages and an active feedback mechanism on the rationale of platelet transfusion by the treating physician and transfusion specialist could significantly reduce platelet consumption during the therapy of acute myeloid leukaemia patients. This is a measure that can be considered by all high-volume haematology centres, which can improve patient safety and reduce costs.

Interleukin-6 and interleukin-8 levels in children with aplastic anemia and its correlation with disease severity and response to immunosuppressive therapy.

Aplastic anemia (AA) is an uncommon condition characterized by pancytopenia and hypocellular bone marrow. Interleukin (IL)-6 and IL-8 have been shown to inhibit myelopoiesis and are major mediators of tissue damage. The primary goal of this study was to determine the IL-6 and IL-8 levels in children with AA, as well as their relationship to illness severity and immunosuppressive medication response. The IL-6 and IL-8 levels were tested in 50 children aged 3-18 years who had AA. As controls, 50 healthy age and sex matched individuals were used. A sandwich enzyme-linked immunosorbent assay kit (solid-phase) was used to measure IL-6 and IL-8 levels quantitatively. The concentrations of IL-6 and IL-8 in pg/mL were used to represent the results. Immunosuppressive medication was given to the patients in accordance with the British Committee for Standards in Haematology Guidelines 2009. The patients' average age was 11.3 ± 3.7 years. Patients with AA had significantly higher IL-6 and IL-8 levels than controls (278.88 ± 216.03 vs. 4.51 ± 3.26; P < 0.001) and (120.28 ± 94.98 vs. 1.79 ± 0.78; P < 0.001), respectively. The IL-6 and IL-8 levels were also investigated with respect to AA severity, with statistically significant differences (P < 0.01) between different grading strata. Patients with very severe AA (VSAA) had the highest IL-6 levels (499.52 ± 66.19), followed by severe AA (SAA) (201.28 ± 157.77) and non-SAA (NSAA) (22.62 ± 14.63). For IL-8 levels, a similar trend (P < 0.01) was detected, with values of 209.81 ± 38.85, 92.12 ± 78.0, and 9.29 ± 10.68 for VSAA, SAA, and NSAA, respectively. After 6 months of immunosuppressive treatment (IST), mean levels of IL-6 and IL-8 in responders and nonresponders were again assessed. The mean IL-6 level in the responders' group (46.50 ± 45.41) was significantly lower, when compared to the nonresponders' group (145.76 ± 116.32) (P < 0.001). Similarly, the mean IL-8 level in the responder's group (33.57 ± 27.14) was significantly lower, compared to the nonresponder's group (97.49 ± 69.00) (P < 0.001). Children with AA had higher IL-6 and IL-8 levels than normal age- and sex-matched controls. Increased levels were linked to the severity of the condition, suggesting that IL may have a role in AA. IL levels can be monitored in AA patients during IST, which can assist in predicting response to IST.

Генри Коттон и Индийский национальный конгресс (1885-1915)

The article examines the contribution of Henry Cotton, a colonial official and politician, to the formation and development of the national movement in India. In the first decades of the existence of the Indian National Congress, English and Anglo-Indian leaders, adherents of liberal views, played a large role in its activities. Henry John Stedman Cotton (1845-1915) was one of the most prominent British supporters of the Congress. The years of life in India, the experience of serving at the lower levels of the colonial administration led Cotton to an analysis of the relationship between the British Empire and its colonies. He argued that the most important task India faced was moral improvement, which required a “social revolution”. It did not consist of overthrowing British power but of involving of Indians to the administration. Result of the “social revolution” should be the creation of the “United States of India”. The driving force of the “social revolution” was “New India”, i. e. European-educated Indians. These ideas brought Cotton closer to the Indian National Congress. After his resignation in 1903, Cotton became a member of the British Committee of the Congress, in 1904 he became president of the session of the Congress. As president, Cotton spoke out against the impending partition of Bengal. Also, the struggle against the partition of Bengal is the main content of Cotton's parliamentary activities in 1906-1910. In the House of Commons Cotton headed an informal Indian Parliamentary Committee, defended Indian revolutionaries and voted for the 1909 Indian Councils Act. Henry Cotton was one of the last Anglo-Indian supporters of the Congress, who stood at the origins of the organization, supported it during its formative years, transferred their administrative and political experience to young Indian leaders. Like A.O. Hume and W. Wedderburn, Cotton saw the future of India in the development of self-government in close connection with the Britain. These views formed the basis of the ideology of the moderate wing of the Congress, which domination in the late 19th century and early 20th century constituted an important stage in the development of the national liberation movement in India.

United Indian Patriotic Association versus Indian National Congress (1888–1893)

The article examines the emergence of Anglo-Indian and Muslim opposition to the Indian National Congress (INC) in the second half of the 1880s – early 1890s. By 1887, Congress had lost the support of the Viceroy of India Dufferin, and it greatly influenced the formation of the anti-Congress movement. The social base of opposition to the Congress was formed by the most conservative parts of society – the Anglo-Indians (the British who permanently lived in India) and Indian Muslims. The center of the anti-Congress movement was the Aligarh College, and the leader was the Muslim educator and founder of the college, Syed Ahmad Khan. The movement received support from the Anglo-Indian press and colonial officials. In 1888, United Indian Patriotic Association was founded with the Muslim organizations of Upper India and the conservative Hindu aristocracy in its ranks. The Association believed that the Congress did not represent the interests of the entire Indian people, but only a narrow stratum of European educated Indians. The INC&amp;apos;s proposals for the introduction of an elective element in legislative councils and simultaneous examinations for civil service in India and Great Britain were regarded as premature, threatening interests of Muslims and British rule in India. The main goal of the United Indian Patriotic Association was to counter the agitation of the INC in Great Britain, where the British Committee of the INC operated, by holding anti-Congress meetings and pamphleting. After the adoption of the Indian Councils Act of 1892, the leaders of the Association focused on protecting the interests of Indian Muslims, and this solution led to the dissolution of the United Indian Patriotic Association in 1893. The Association became one of the first organizations opposed to the INC and had a significant impact on strengthening the political activity of Indian Muslims. The emergence of Muslim opposition to INC in the second half of the 1880s. became an important factor in the political development of India and the national liberation movement in the first half of the XX century.

Obituary: Samuel J. Machin MB ChB FRCP FRCPath, 26 March 1949 – 2 October 2021

On Saturday 2 October, we were saddened to learn of the death of Professor Samuel (Sam) Machin after a short, final illness. Sam was a larger than life character who had a certain vision about how haematology should be and strived to achieve modernization. Through his distinguished career, he was involved with many of the National and International societies and committees involved in haematology and standardization. Sam studied medicine at Sheffield University from 1966 to 1971. He received his haematology training at Manchester Royal Infirmary before taking a Senior Registrar post at the Middlesex Hospital Medical School. In 1979, he joined Jos Vermylen and others at the Department of Vascular and Haemostasis Research, KU, Leuven. It was here where he commenced his career in haemostasis and thrombosis, researching on platelets, prostacyclin and haemolytic uraemic syndrome. Returning to London, he was appointed Consultant Haematologist (the youngest at the time to achieve that post in the UK) and worked with Professor Jimmie Stewart. Sam’s career progressed with his achievements leading to his appointment as Professor of Haematology at The Middlesex and later University College London (UCL). A large number of scientists and junior doctors received expert training in the Department, many obtaining MD and/or PhD. Almost without exception, trainees whom Sam mentored and supported have gone on to become consultants, professors, heads of department and divisions in hospitals, universities, the National Blood Service and industry. He took an active role in organizing the UCL Haemostasis Training Course, which helped haematologists from many parts of the world to obtain Fellowship of the Royal College of Pathologists. In 1981, Sam founded what was to become the Haemostasis Research Unit at UCL and directed research in many aspects of haemostasis and thrombosis. His primary areas were platelet function, thrombotic thrombocytopaenia, antiphospholipid syndrome and the prothrombotic effects of combined oral contraceptives. He was also interested in laboratory automation and set up an analyser and reagent evaluations unit that studied most new haematology and coagulation systems. He understood the need to communicate and encouraged staff to present their data at conferences, and he co-authored over 400 peer-reviewed publications. Sam worked tirelessly in supporting the interests of many societies and organizations. He was President of the British Society for Haemostasis and Thrombosis (2001-03) and British Society for Haematology (2005-07), serving as treasurer from 1994 to 2000. He chaired the British Committee for Standardisation in Haematology, UK NEQAS Haematology Steering Committee (2006-11) and the International Council for Standardization in Haematology (2007-20). He was Treasurer of the International Society for Thrombosis and Haemostasis (ISTH) for the 2003 congress in Birmingham and Vice Chairman of the ISTH Scientific Standards Committee. In 2007, Sam led the reorganization and modernization of the International Council for Standardization in Haematology and remained as Chair of this body until 2020. His enthusiasm and energy resulted in the publication of more than 30 peer-review publications on standardization in haematology, including many guidance and recommendation documents. He was a supporter of laboratory haematology as a discipline. He encouraged the late Berend Houwen to develop further meetings on “Technical Innovations in Laboratory Hematology,” which later led to the formation of the International Society for Laboratory Hematology, of which Sam became a board member. He served on the Editorial Board of this journal (International Journal of Laboratory Hematology) and remained an active reviewer (even saying just 2 weeks prior to his death that he would like to receive more manuscripts). Sam enjoyed playing and watching sport, being passionate about cricket, hockey and rugby league. A kind and generous man, although sometimes controversial because he liked to speak his mind. He had a way of cutting through bureaucracy, side stepping obstacles and getting things done. He is survived by his wife Jean, son Robert and daughters Clare and Rowena as well as 5 grandchildren.

Guidelines: the same evidence but different conclusions - relaxation of indications for irradiation of cellular blood components?

Guidelines: the same evidence but different conclusions - relaxation of indications for irradiation of cellular blood components?

A retrospective audit to evaluate the appropriateness and rationalization of Fresh Frozen Plasma usage in a tertiary care hospital

BackgroundGeneral guidelines describing the potential indications and contraindications of Fresh Frozen Plasma (FFP) exist. However, their implementation is inadequate, leading to inappropriate use in various clinical settings. This study aims to define the appropriateness of the FFP usage in terms of therapeutic versus prophylactic indications. MethodsRetrospective audit was conducted over one year prior to and after an educational intervention (1122 patients for 6072 FFP units and 1061 patients for 4858 FFP units, respectively). Clinical diagnosis, indication for FFP transfusion, and coagulation profile were noted, and episodes of transfusion were divided into appropriate and inappropriate based on the guidelines of the British Committee for Standards in Hematology (2004 reviewed in 2018) and College of American Pathologists (1994). ResultsInitial audit found 51.8% of FFP transfusions to be inappropriate (3069 of 5922). Coagulation profile (with INR values less than 1.5 times of the normal) was the most common cause of inappropriate transfusion (15.08%). 56.7% of FFP were prophylactically transfused. Re-audit after educational interventions showed a 22.3% reduction in the number of inappropriate transfusions. ConclusionInappropriate, as well as high prophylactic usage of FFP, was noticed in the initial audit, which reduced significantly after educational interventions. Regular CMEs, interactive sessions with clinicians, functioning Hospital Transfusion Committees, and prospective audits can affirm, further improve and reinforce the existing Hospital Transfusion Guidelines.

Second Line Systemic Treatments Including Extracorporeal Photopheresis Among Patients with Chronic Graft Versus Host Disease (cGVHD) in the United States, 2009-2016

Introduction: Extracorporeal photopheresis (ECP) is a cell-based immunomodulatory therapeutic procedure approved by the FDA for cutaneous T-cell lymphoma (CTCL) among individuals who have not been responsive to other forms of treatment in the United States (US). As clinical evidence accumulated over the years, Centers for Medicare & Medicaid Services (CMS) issued several Medicare National Coverage Decisions (NCDs) for coverage of ECP in patients with acute cardiac allograft rejection or chronic graft versus host disease (cGVHD), who are, refractory to standard immunosuppressive drug treatment. In contrast, per British Committee for Standards in Haematology (BCSH) guidelines on treatment of cGVHD, ECP is recommended as the first option over other 2nd-line systemic treatments including rapamycin (mTOR) inhibitors, pentostatin, rituximab, and imatinib. The objective of this analysis was to describe real-world use of ECP in patients with cGVHD in the US between 2009 and 2016.Methods: A retrospective analysis was conducted using the Truven Health MarketScan® Commercial and Medicare Supplemental claims databases (2009-2016). Adult (≥18 years) cGVHD patients receiving 2nd-line systemic treatments, with continuous health plan enrolment 3 months prior to first cGVHD diagnosis (i.e., baseline period) and 6 months following the initiation of 2nd-line systemic treatment were included. Patient demographic and clinical characteristics were summarized by type of 2nd-line systemic treatment (ECP vs. non-ECP). In addition, treatment patterns including the time from cGVHD diagnosis to initiation of 2nd-line systemic treatment, duration of ECP treatment (ie, time from initiation to end of ECP treatment), and ECP use (proportion of patients receiving ECP treatment among those receiving 1 of the 5 2nd-line systemic treatments) by year were reported. Annual per person all-cause cost for cGVHD patients for emergency room (ER) visits, office visits, and inpatient visits incurred after receiving 2nd-line systemic treatment (ie, the follow-up period) were also reported.Results: Of the 3086 adult cGVHD patients, 663 (21.5% of patients with cGVHD) patients had ≥2 claims for 2nd-line systemic treatments, of which 464 met the continuous enrollment criterion and were included in the study (mean age=49.7 years; 60.1% males). The most commonly reported underlying conditions at baseline were bone marrow transplant (268 [57.8%]), stem cell transplant (280 [60.4%]) and CTCL (25 [5.4%]). The average time from first cGVHD diagnosis to initiation of 2nd-line systemic treatment was 5.4 months. Among patients receiving 2nd-line systemic treatments, 210 (45.3%) received ECP treatment for an average duration of 11.1 months. ECP and non-ECP patients were similar in terms of demographic and clinical characteristics, with organ transplant as the most common underlying condition during the baseline period. As the number of cGVHD patients increased from 16 in 2009 to 100 in 2016, ECP use increased from 31.3% in 2009 to 54.0% in 2016. The total annual all-cause per patient cost was $190,148, including $4619 for ER visits, $8,673 for office visits, and $176,856 for hospitalizations during the follow-up period.Conclusions: Results from the latest US commercial administrative claims data pointed to an increase rate of cGVHD between 2009 and 2016. Of the 464 study patients with cGVHD, 2nd-line systemic treatment was initiated 5.4 months following the first diagnosis of cGVHD. As the number of cGVHD patients increased the rate of ECP use increased over time as well. During the study period, ECP was used by 45.3% of study patients with average duration of 11.1 months. In addition, high economic burden was reported among cGVHD patients receiving 2nd-line systemic treatments. DisclosuresJoshi:Pharmerit International: Employment; Mallinckrodt Pharmaceuticals: Research Funding. Luo:Mallinckrodt Pharmacueticals: Research Funding; Pharmerit International: Employment. Huang:Mallinckrodt Pharmaceuticals: Employment. Mitri:Mallinckrodt: Employment. Lovelace:Mallinckrodt Pharmaceuticals: Employment. Pham:University of California, School of Pharmacy: Employment; Mallinckrodt Pharmaceuticals: Employment. Gao:Mallinckrodt Pharmaceuticals: Consultancy, Employment.

Sickle cell disease and the adherence to guidelines for the use of blood transfusions in Duhok, Kurdistan, Iraq

Background and objective: One of the important health problems in Duhok city, Iraqi Kurdistan Region, is sickle cell disease. Blood transfusion remains a significant therapeutic intervention in patients with sickle cell disease that reduces complications related to vaso-occlusions. This study aimed to assess compliance to guidelines for the use of blood transfusionsin Duhok, Kurdistan, Iraq. Methods: This is a cross-sectional study that included 135 patients with sickle cell disease registered at Jeen center of pediatric hematological diseases in Duhok, Kurdistan, Iraq. Between April 1st and July 31st, 2019, 205 medical visits of sickle cell disease were registered. Every patient was evaluated to record the clinical setting and explanations behind visiting and indications for transfusion. Results: Of 135 patients,65.9% had sickle cell anemia (HbSS disease), 33.3% had sickle beta thalassemia, and one patient (0.7%) had Sickle/D disease. A total of 205 medical visits of sickle cell disease were registered with 84 blood transfusion decisions. The most common indicated guideline reasons for transfusion were symptomatic anemia and acute hemolytic crisis with a drop of hemoglobin &gt;2 g/dl below steady state hemoglobin and severe painful crisis only accounted for 38.1%. Conclusion: In this study of patients with sickle cell disease, most blood transfusions were not indicated according to the transfusion guidelines (British Committee for Standards in Haematology – BCSH, 2017). Keywords: Transfusion guidelines for sickle cell disease (BCSH 2017); Sickle cell disease; Iraq.

Diagnosis and management of von Willebrand disease: A community-wide effort to deliver evidence-based clinical practice guidelines.

Diagnosis and management of von Willebrand disease: A community-wide effort to deliver evidence-based clinical practice guidelines.

Correcting dominant‐negative von Willebrand disease

Correcting dominant‐negative von Willebrand disease

К ИСТОРИИ ВОЗНИКНОВЕНИЯ ИНДИЙСКОГО ПАРЛАМЕНТСКОГО КОМИТЕТА В БРИТАНСКОЙ ПАЛАТЕ ОБЩИН

The aim of this article is to study the history of the formation of the Indian Parliamentary Committee (IPC) in the British House of Commons in 1893. To achieve this aim, the following objectives are envisaged: determination of reasons for establishing the IPC; analysis of the activities of the Indian National Congress and British liberals; analysis of the election campaign of Dadabhai Naoroji, which enabled him to get a seat in the House of Commons in 1892. The sources of the study are the pamphlets of the Indian National Congress members, which explain the need for Indian representatives to participate in the British Parliament; records of parliamentary hearings on the Indian issue; materials of the press describing the course of the election campaign of 1892 and the tasks of the Indian Committee in Parliament. In the course of the study, the author came to the following conclusions. The moderate branch in the Indian liberation movement considered the British Rule in India to be a progressive phenomenon in the Indian life. The defects of the British administration were due to the fact that the English people and Parliament did not understand the problems that the Indian population faced under the British Rule. The Parliamentary Committee dealing exclusively with the Indian issue could contribute to solving this problem. The main conductor of this idea in India was the National Congress, which, since its inception, began work on the formation of the IPC. In the late 1880s, an Indian political agency, which intensified attempts to organize an Indian committee in Parliament, was established in London. The interests of the Indians in the House of Commons at that time were defended by the Liberal MP Charles Bradlaugh. On the basis of the proposals of the National Congress, he prepared a bill on Indian councils, which came into force in 1892. Nevertheless, the creation of the Indian Parliamentary Committee became possible only in 1893, when Dadabhai Naoroji and William Wadderburn (founders of the British Committee of the Indian National Congress) were elected to the House of Commons as Liberal MPs. In general, the creation of the IPC was a progressive step in the development of the Indian liberation movement because the IPC gave the moderate nationalists and their British liberal supporters new tools of fighting for the rights of Indian subjects of the British Empire. The appearance of supporters of Indian reforms in Parliament was the evidence of the success of the IPC’s course of expanding political agitation in England, although it did not guarantee significant achievements in solving of the Indian question.

Analysis of red blood cell irradiation practices from South India.

INTRODUCTION:Age of red blood cell (RBC) units at the time of irradiation is important and prolonged storage of preirradiated units is detrimental. The objectives were to determine RBC age at irradiation, days from expiry (DFE), and percentage of late transfusions of irradiated RBC. To estimate the concordance on expiry of irradiated RBC units with present American Association of Blood Banks (AABB)/Directorate General of Health Services (DGHS), New Delhi over British Committee for Standards in Hematology (BCSH) and Council of Europe (CE) guidelines.METHODS:All the RBC units irradiated for a 1 year period were included. Retrieved data included date of collection, irradiation, revised expiry, and issue of blood. Late transfusions are units transfused in the last 2 week of RBC's shelf-life and wastage due to expiry was determined. Chi-square and Kruskal–Wallis test were used for comparisons between the guidelines.RESULTS:Out of 1303 RBC units irradiated, the median age for irradiation was 2 (0–36) days and 99.3% units irradiated within day +14. Median DFE for these units transfused was 26 (0–28) days. 2.8% units expired as per local standards. Late transfusions happened in 121 (9.3%) units transfused. AABB/DGHS practice was not concordant with CE standards for 86 (6.6%) units and with BCSH 94 (7.2%) units. Overall discordance between the present practices was CE and BCSH was seen in 130 (10%) events.CONCLUSION:Median RBC irradiation age and DFE was two and 26 days respectively at our center. Only 90% concordance was observed between AABB/DGHS and CE/BCSH guidelines with 9.3% units transfused as late transfusions. Restricting late transfusions of irradiated RBC can act as surrogate to improve the quality of units transfused through an inexpensive strategy.

Особенности вязко-эластических свойств сгустка крови и проявления геморрагического синдрома при тромбоцитопении у онкогематологических больных

Введение. Тромбоцитопения является частым осложнением онкогематологических заболеваний, которое провоцирует развитие геморрагического синдрома. Уровень тромбоцитов в периферической крови, являющийся пороговым для переливания концентрата тромбоцитов (КТ), окончательно не установлен. Применение тромбоэластографии (ТЭГ) при тромбоцитопениях у онкогематологических больных может повысить прогностические возможности определения риска кровотечений. Цель исследования: оценить вязко-эластические свой ства сгустка крови при тромбоцитопении менее 50×109/л и их взаимосвязь с проявлениями геморрагического синдрома у онкогематологических больных. Материалы и методы. В исследование включено 84 пациента с гемобластозами и тромбоцитопенией менее 50×109/л, 54 (64%) мужчины и 30 (36%) женщин, медиана возраста — 54 года. В зависимости от уровня тромбоцитов в периферической крови пациентов разделили на 2 группы: группа 1 — 44 пациента с числом тромбоцитов от 25 до 50×109/л, группа 2 — 40 больных с содержанием тромбоцитов менее 25×109/л. Исследовали показатели периферической крови, коагулограммы и ТЭГ. Степень тяжести кровотечений оценивали по шкале проявлений геморрагического синдрома (ВОЗ) и по шкале оценки побочных явлений Национального института рака (США). Результаты. Гипокоагуляция по ТЭГ в группе 1 выявлена в 46% случаев, в группе 2 — в 75%. Значимые межгрупповые различия показателей ТЭГ получены только в отношении максимальной амплитуды. Геморрагический синдром в группе 1 диагностирован у 6 (13%) пациентов, в группе 2 — у 14 (35%). Однако предиктивная роль влияния количества тромбоцитов на частоту развития геморрагического синдрома не установлена (β = 0,016; p = 0,92). Сочетание тромбоцитопении и гипокоагуляции по ТЭГ проявлялось в виде геморрагического синдрома в 3,3 раза чаще, чем без гипокоагуляции (RR = 3,3; 95% ДИ = 1,20–9,05). В ряде случаев основанная на результатах ТЭГ трансфузионная тактика позволила избежать переливания КТ при инвазивных манипуляциях у больных с тромбоцитопенией менее 25 × 109 / л. Заключение. Глубина тромбоцитопении не является надежным предиктором геморрагического синдрома. Применение ТЭГ у пациентов с тромбоцитопенией позволяет оптимизировать трансфузионную тактику, избежав ненужных переливаний КТ. Сочетание тяжелой тромбоцитопении с гипокоагуляцией по данным ТЭГ служит показанием для профилактических трансфузий КТ. Background. Thrombocytopenia is a frequent complication of hemoblastosis that causes hemorrhagic syndrome. The threshold of peripheral blood platelet count for transfusion of platelet concentrate is discussed. Thromboelastography (TEG) can be considered as additional prognostic method for bleeding risk assessment in thrombocytopenic patients with leukemia. Objectives: to study changes in the viscoelastic properties of blood clot in hemoblastosis patients with thrombocytopenia less than 50×109/L and their relationship with the manifestations of hemorrhagic syndrome. Patients/ Methods. The study included 84 hemoblastosis patients — 54 (64%) men и 30 (36%) women with thrombocytopenia less than 50 × 109/L, median age — 54 years. All patients are divided into 2 groups according to the platelet count: Group 1 — 25–50×109/L, Group 2 — less than 25×109/L. Peri pheral blood counts, TEG and coagulogram parameters were evaluated in both groups. Manifestations of hemorrhagic syndrome were assessed according to the WHO bleeding scale and Common terminology criteria for adverse events of the National Cancer Institute (USA). Results. Hypocoagulation according TEG in Group 1 was found in 46% of cases, in Group 2 — in 75%. Significant intergroup differences in TEG parameters were obtained only in maximum amplitude. Hemorrhagic syndrome in Group 1 diagnosed in 6 (14%) patients, in Group 2 — in 14 (35%). There was no dependence of hemorrhagic syndrome frequency on the severity of thrombocytopenia (β = 0.016; p = 0.92). The combination of thrombocytopenia and hypocoagulation according TEG manifested as a hemorrhagic syndrome 3.3 times more often than without hypocoagulation (RR = 3.3; 95% CI = 1.20–9.05). In some cases, TEG-based transfusion tactics allowed to avoid unnecessary platelet concentrate transfusion during invasive procedures in patients with thrombocytopenia less than 25 × 109/L. Conclusions. Severity of platelet depletion is not accuracy predictor for hemorrhagic events. Use of TEG in patients with thrombocytopenia allows to optimize the transfusion tactics and to avoid unnecessary platelet concentrate transfusions. The combination of severe thrombocytopenia with hypocoagulation according TEG serves as indication for prophylactic platelet concentrate transfusion.

Клинические примеры применения фактора VIII свертывания крови с фактором Виллебранда у рожениц с III типом болезни Виллебранда

Болезнь Виллебранда (БВ) может представлять определенные трудности у рожениц с данной патологией. Приведены 2 клинических примера использования у женщин с БВ фактора VIII свертывания крови с фактором Виллебранда, показана эффективность и безопасность их применения. У одной пациентки было также показано использование фактора свертывания крови VIII с фактором Виллебранда во время экстракорпорального оплодотворения. Von Willebrand disease presents a certain hemostatic problem among parturients. This article shows the effectiveness and safety of using coagulation factor VIII with von Willebrand factor for the prevention of bleeding in childbirth in 2 patients with type 3 von Willebrand disease. In one patient, the use of coagulation factor VIII with von Willebrand factor during in vitro fertilization was also shown.

Massive blood loss protocol 'Code Red' at Papworth Hospital: A closed loop audit.

AimTo investigate if the massive blood loss protocol ‘Code Red’ at a specialist cardiothoracic hospital was activated according to local and national guidelines by a closed loop audit.MethodsElectronic and paper patient care systems were searched in 2015 and 2018 to access records for the ‘Code Red’ activations. Activation of the massive blood loss protocol was compared against the national standards set by The British Committee for Standards in Haematology. The percentage of cases meeting each of the ten standards in the specialist cardiac unit’s Protocol for the Management of Massive Blood Loss in Adults (adapted from the national standards) were evaluated.Results‘Code Red’ protocol was activated on 18 occasions in 2015 and nine occasions in 2018, representing just 0.83 and 0.26% of emergency surgeries, respectively. Between 2015 and 2018, there was a 6% increase of ‘Code Red’ cases being appropriately activated, a 26% increase in the prompt notification of the haematology department upon activation, alongside a 30% increase in the timely delivery of blood products, and a 25% decrease in the average amount of blood transferred prior to ‘Code Red’ activation.ConclusionThere has been an improvement in the standards of care and management of massive blood loss this specialist cardiac centre despite the target timeframe being reduced from 30 to 15min between 2015 and 2018. Preparation for and anticipation of massive blood loss has likely decreased the number of incidences requiring ‘Code Red’ activation, permitting delivery of safe patient care.