Plasma Of Patients Research Articles

Relationship between plasma fibrinogen level and obstructive sleep apnea

Abstract Background Obstructive sleep apnea (OSA), which causes recurring hypoxemia owing to upper airway closure, is one of the most frequent sleep disorders. OSA patients are more prone to suffer cardiovascular disease (CVD) and stroke. One primary mechanism connecting OSA with cardiovascular problems is the prothrombotic state. Our goal in this research is to confirm the relationship between plasma fibrinogen levels and OSA. Results A case–control study involved 20 adults, non-obese participants who had been recently diagnosed with OSA, had never been treated for OSA before, and did not have any other preexisting conditions, and 20 controls underwent measurement of plasma fibrinogen levels following whole night polysomnography. The patient's plasma fibrinogen levels were substantially more significant than the controls' (399.8 ± 54.7 versus 309.8 ± 26.7 mg/dL, respectively), with a p-value of less than 0.001. Plasma fibrinogen levels in moderate and severe OSA (383.6 ± 20.6 mg/dL and 454.4 ± 25.6 mg/dL, respectively) were significantly higher than in controls (309.8 ± 26.7 mg/dL) (p < 0.001 and p < 0.001) and mild OSA patients (335 ± 27.8 mg/dL) (p = 0.013 and p < 0.001). Plasma fibrinogen levels were not significantly different between the controls and patients with mild OSA (p = 0.219). Apnea–hypopnea index, arousal index, and oxygen desaturation index showed positive correlations with plasma fibrinogen (r = 0.953, 0.888, and 0.894, p = < 0.001, < 0.001, and < 0.001, respectively). The total sleep time, sleep efficiency, N3%, REM%, and lowest oxygen saturation showed negative correlations (r = − 0.860, − 0.877, − 0.611, − 0.844, and − 0.745, p = < 0.001, < 0.001, < 0.001, and < 0.001, respectively). Conclusion Elevated levels of plasma fibrinogen in individuals with moderate-to-severe OSA may be attributed to sleep apnea and these increased levels could serve as a significant risk factor that establishes a connection between OSA and pathology of the cardiovascular and cerebrovascular systems. These results could significantly affect OSA diagnosis, therapy monitoring, and outcome.

Using Soluble CD38 to Overcome Daratumumab Interference in Pretransfusion Compatibility Testing

Background: CD38 is a protein highly expressed on myeloma (MM) cells that has been shown to be an effective target antigen for monoclonal antibody therapies, so treatment with anti-CD38 monoclonal antibodies is a first line therapy for patients with MM. Although CD38 is weaker expressed on erythocytes anti-CD38 binds to CD38 on reagent RBCs and cause panreactivity in vitro and subsequent false positive reactions in indirect antiglobulin tests (IAT), antibody detection (screening) tests, antibody identification panels, and anti-human globulin (AHG) crossmatches. These findings suggest that the soluble CD38 method could improve transfusion safety for patients receiving anti-CD38 therapy, particularly in urgent clinical settings This study aims to evaluate the effectiveness of a new soluble CD38-based method in mitigating Daratumumab interference during pretransfusion compatibility testing." Methods: We evaluated the Grifols sCD38 method in 20 patients and compared it with the DTT method Results: In our experience the sCD38 method reduced testing time from 150 to 50 minutes and demonstrated 100% efficacy, compared to 90% with DTT. The sCD38 effectively mitigated the interference caused by anti-CD38 antibodies in 10 (100% efficacy) of patient samples tested while DTT was successful in only 9/10 (90% efficacy); no interference was observed in patients presenting anti erythrocyte antibodies. Moreover, there was no negative influence on DTT sensitive blood group systems such as KEL upon sCD38 treatment. Conclusions: In our Laboratory, in the year 2023, we processed 129 patients treated with anti-CD38. Therefore the reduction from 150 to 50 minutes in the time needed to perform tests for mitigation of anti-CD38 interference appears to be relevant with a recovery of approximately 210 technical-hours per year. Another highly appreciated operational aspect was the possibility of treating the patient's plasma and perform tests using automatic instruments (Erytra Grifols) available in our laboratory. In the evaluation of this new method, we did not observe failures in the mitigation of anti-CD38 interference. Furthermore, the results obtained in the samples that presented allo or auto antibodies were not affected by the treatment with sCD38. In our experience Grifols sCD38 assay is straightforward and quick to perform ant it is superior to DTT treatment in the mitigation of anti-CD38 antibody interference in MM patients treated with Daratumumab.

Misleading antigenic von Willebrand factor levels in acquired von Willebrand syndrome secondary to monoclonal gammopathy of undetermined significance.

In the diagnosis and treatment of acquired von Willebrand syndrome (AVWS), von Willebrand factor (VWF) antigen levels (VWF:Ag) are helpful for quantifying blood VWF-protein levels. Most clinical laboratories measure VWF:Ag by latex immunoassay (LIA), but underlying diseases of AVWS may influence LIA results. A 60year-old AVWS patient with immunoglobulin G (IgG) kappa-type monoclonal gammopathy of undetermined significance (MGUS) showed reduced VWF activity but normal levels of VWF:Ag. His VWF multimers were broadly decreased, which represented a large discrepancy with VWF:Ag. To investigate the mechanism of this discrepancy, we measured the patient's plasma VWF:Ag by in-house enzyme-linked immunosorbent assay (ELISA) and LIA. We also purified the IgG fraction from the patient's serum and measured VWF:Ag in VWF-deficient plasma supplemented with this fraction. VWF:Ag measured by in-house ELISA (VWF:AgELISA) was much lower than that measured by LIA (VWF:AgLIA), which indicated reduced VWF-protein volume in blood. Indeed, VWF:Ag was detected by LIA in VWF-deficient plasma spiked with a patient-derived IgG fraction. These results suggest that LIA detected a non-specific immunoreaction and overestimated the patient's VWF:AgLIA. Clinicians should be aware that underlying diseases of AVWS could influence the LIA system, and interpret VWF:Ag cautiously.

Abdomen Malignant Myxoid Leiomyosarcoma with PDGFRA and TP53 Missense Mutation: A Case Report

Background: Malignant myxoid leiomyosarcoma (MMLS) is most commonly found in the uterus but can also occur in other areas, such as the extremities, vulva, chest wall, and abdominal cavity. This cancer is more prevalent in women and has a poor prognosis with a high rate of recurrence and a significant percentage of metastasis. Case Representation: Herein, we report the case of a 64-year-old female patient who presented with 3-month history of left lower abdominal mass. The patient underwent abdominal malignancy resection and was subsequently diagnosed with myxoid leiomyosarcoma. The patient experienced a recurrence and metastasis with significant ascites after the initial surgery and did not respond to treatment with oral Anrotinib in combination with Tislelizumab immunotherapy. Further genetic testing using next-generation sequencing (NGS) identified missense mutations in the PDGFRA and TP53 genes in the patient's plasma, but no mutations in the KIT gene were detected. Immunohistochemical analysis of the tumor tissue also revealed a negative expression of PD-L1. As a result, we altered her targeted therapy to Avapritinib, which resulted in significant improvement in her symptoms, including abdominal distension and pain, a decrease in ascites, and the KPS score increased from 60 points before treatment to 90 points after treatment SD (stable disease) was achieved for three months after treatment. Conclusion: In this case report, we present the instance of a patient with malignant myxoid leiomyosarcoma with a missense mutation in both the PDGFRA and TP53 genes. We found that targeted therapy with Avapritinib was effective in achieving a positive outcome in this patient. Our findings suggest that genetic detection is possible to better understand the biological behavior, genetic characteristics, and patient's response and tolerance to certain drugs, thus selecting the best treatment plan for the patient. Avapritinib may be a promising new treatment option for leiomyosarcoma patients with similar genetic mutations.

#1389 Identification of serum lipidomic profile in nephrotic syndrome patients

Abstract Background and Aims Nephrotic syndrome describes a collection of symptoms, mainly heavy proteinuria leading to kidney function loss, that can be caused by different underlying kidney diseases. Common primary causes of nephrotic syndrome include focal segmental glomerulosclerosis (FSGS), minimal change disease (MCD) and membranous nephropathy (MN). Nephrotic syndrome is often characterized by plasma lipid abnormalities with elevations in cholesterol, triglycerides and lipoproteins. Here we set out to generate a detailed lipidomic analysis of FSGS, MCD and MN patient's plasma to find lipid changes common to nephrotic syndrome or specific for the underlying disease. Method For this lipidomic study, we included patients with primary FSGS (2 cohorts with n = 5), genetic FSGS (n = 5), MCD (n = 5) and MN (n = 5) in whom serum had been collected at the time they presented at our center with active nephrotic syndrome. We compared the serum lipidome of nephrotic syndrome patients with age matched healthy controls (n = 5), and with age matched patients with familial hypercholesterolemia (n = 5) who, like patients with nephrotic syndrome, have significantly elevated lipid values. Serum was analyzed using the Shotgun Lipidomics platform by Lipotype GmbH (Dresden, Germany), as previously described [1]. Results The lipidomic profile of patients with nephrotic syndrome was markedly different compared to control groups (Fig. 1A). In particular, lower levels of lyso-phophatidylcholine (LPC) and higher concentrations of phosphatidylethanolamine (PE) and lyso-PE (LPE) compared to control groups were most prominent (Fig. 1B). Subspecies analysis identified LPC 16:0;0 to be highly downregulated in patients with nephrotic syndrome (Fig. 2A), whereas LPE 18:0;0 and nearly all PE subspecies were increased compared to control groups (Fig. 2B and C). The lipidomic profile was largely comparable between different underlying diseases and we could not identify lipid classes specifically different for certain diseases. Conclusion Our lipidomic data show that patients with nephrotic syndrome have a distinct lipid profile compared to healthy controls or other disease controls. We identified LPCs, PEs and LPEs to be changed in nephrotic syndrome. We could not identify lipids specific for certain diseases underlying nephrotic syndrome, but rather identified a general nephrotic syndrome lipid profile. This suggests that lipid changes are rather a consequence of disease manifestation in these patients with various underlying causes. Further research should focus on confirming this lipid profile in larger cohorts and unraveling the mechanisms leading to the observed lipid changes.

Retrospective evaluation of indications for therapeutic plasmapheresis procedures applied in our center

Aims: Therapeutic plasma exchange (TPE) is a process in which pathological substances (autoantibodies, alloantibodies, immune complexes, lipoproteins, cryoglobulins, etc.) in the patient's plasma are removed from the body along with the patient's plasma and replaced with replacement fluid (allogeneic donor plasma, colloid, crystalloid). It is applied as a complementary treatment method in many diseases that can cause high morbidity and mortality, either in the primary treatment of the disease (main treatment) or as an adjunctive treatment in the main treatment of the disease. Today, TPE is increasingly used in various clinics (toxicology, endocrinology, etc.) for different diseases/causes, especially in hematological, neurological, and nephrological diseases. Methods: Adult patients who underwent therapeutic plasma exchange in our therapeutic apheresis center between May 2017 and May 2019 were included in the study, and the data were obtained by retrospectively reviewing patient records in the therapeutic apheresis center and our hospital's automation system. Results: In the two-year period, a total of 1957 TPE procedures were performed on 441 patients. It was determined that 255 of the patients undergoing TPE procedures (57.8%) had indications related to liver diseases (acute liver failure, acute exacerbation of chronic liver failure, and rejection after liver transplantation), while 186 (42.2%) had indications related to non-liver diseases. Among the 186 patients undergoing TPE for non-liver diseases, it was found that 69 (37.1%) were for hematological, 38 (20.4%) for neurological, 32 (17.2%) for renal, and 47 (25.3%) for other diseases. Conclusion: Due to the large number of liver transplants performed in our Liver Transplant Institute, the majority of TPE indications at our hospital are related to liver diseases. However, the evaluation of TPE indications excluding liver diseases revealed that the indications and frequencies of patients undergoing TPE were consistent with the overall results reported in studies from both our country and abroad.

Variants APOA5 p.G185C and p.S19W associated with early-onset severe hypertriglyceridemia-induced pancreatitis and diabetes complications in a Vietnamese girl

An imbalance of glucose and severely high triglyceride are the key characteristics driving hypertriglyceridemia and hyperlipidemic pancreatitis. Hereditary factors considerably promote the increase of triglyceride levels and secondary complications. This study explored the clinical characteristics and genetic causes of a young girl with recurrent severe hypertriglyceridemia-developed pancreatitis at 9-year-olds and diabetes mellitus appearance at 14-year-olds. At 20 years old, she was admitted to the hospital in critical condition and had pancreatitis pain with triglyceride level at 26.22 mmol/L, HbA1c 15%, and glucose at 21.3 mmol/L. Whole exome sequencing analysis showed that she had two heterozygous variants of the APOA5 gene, (p.G185C and p.S19W), one homozygous variant of the APOE gene (p.C156R), which were previously reported to cause critical hypertriglyceridemia condition of patients. The results and analysis propose these variations were the underlying causes of a heightened of patient's plasma triglycerides and lead metabolic complication onset at a young age. These findings shed light on the molecular mechanism of her elevated plasma triglyceride and the early onset of diabetes following hyperlipidemic pancreatitis.

The role of therapeutic plasma exchange in plasma cell disorders.

Therapeutic plasma exchange (TPE) is an extracorporeal technique where patient's plasma containing pathogenic substances is separated and removed from the whole blood, while the cellular component is returned to the patient mixed with replacement solution via an apheresis machine. Due to its ability to remove pathogenic substances from plasma including immunoglobulins, TPE has proven efficacious in the management of various disorders across different medical disciplines, including plasma cell dyscrasias, which are characterized by the abundant secretion of non-functional immunoglobulins produced by an abnormally proliferating plasma cell clone. This review summarizes the current indications of TPE in plasma cell-related disorders and discusses its application, safety, and therapeutic effects.

Meeting the transfusion needs of a patient with anti-Ena requires an international effort.

This extraordinary case showcases the identification of a rare anti-Ena specificity that was assisted by DNA-based red blood cell antigen typing and collaboration between the hospital blood bank in the United States, the home blood center in Qatar, the blood center Immunohematology Reference Laboratory, as well as the American Rare Donor Program (ARDP) and the International Society for Blood Transfusion (ISBT) International Rare Donor Panel. Ena is a high-prevalence antigen, and blood samples from over 200 individuals of the extended family in Qatar were crossmatched against the patient's plasma with one compatible En(a-) individual identified. The ISBT International Rare Donor Panel identified an additional donor in Canada, resulting in a total of two En(a-) individuals available to donate blood for the patient.

NLRP3 concentration, oxidants, and antioxidants in plasma of endometriosis patients undergoing treatment with dienogest

ObjectiveNOD-like receptor pyrin domain-containing 3 (NLRP3) is a cytosolic multi-protein complex that induces inflammation and is negatively regulated by progesterone. Previous researches have reported abnormal induction of reactive oxygen species (ROS) and progesterone resistance in endometriosis (EM). Since progesterone regulates ROS level and, consequently, inflammation, our objective is to investigate whether dienogest (DNG) regulates NLRP3 and whether the regulation of NLRP3 inflammasome by DNG in the blood plasma of patients with EM can affect oxidant and antioxidant markers. MethodsPlasma samples were obtained from control and EM patients experiencing pain symptoms to measure the level of NLRP3, oxidants, and antioxidants. Subsequently, these patients were given oral DNG 2 mg/day for six months for drug treatment. After six months, plasma samples were collected from the patients for re-examination. ResultsThe findings indicate that DNG reduced NLRP3 concentration and oxidant production while increasing antioxidant production in blood plasma. By reducing NLRP3, DNG was able to alleviate inflammation and pain caused by inflammation in EM patients. ConclusionIn conclusion, the use of DNG in EM patients resulted in a decrease in NLRP3 concentration in the patient's plasma. Furthermore, this effect was enhanced by balancing oxidant/antioxidant levels, which may contribute to reducing inflammation associated with EM.

Plasma Exchange in Pediatric Neurology Patients: A Single-Center Experience.

Therapeutic plasma exchange (TPE) is a procedure involving the filtration of a patient's plasma to eliminate pathogenic components or address deficiencies. This technique finds varied indications in the pediatric age group, particularly in neuroinflammatory diseases. The objective of this study is to delve into our local experience with TPE, focusing on indications, outcomes, and complications among children with neurological diseases at King Abdulaziz University Hospital (KAUH) in Jeddah, Saudi Arabia. Conducted at the pediatric department of KAUH in Jeddah from November 2008 to July 2023, this retrospective cohort study examined 15 patients, revealing a notable male predominance with 12 male patients (80%) and three female patients (20%). About two-thirds of patients exhibited an average illness severity, with a Glasgow Coma Scale (GCS) score of 10.7 and anExpanded Disability Status Scale (EDSS) score of 4.8. The median length of hospital stay was 23 days, and in the pediatric intensive care unit (PICU), it was 8.5 days. Presenting symptoms included limb weakness (n = 6), loss of consciousness (n = 3), dysphagia (n = 3), photophobia (n = 1), and ascending paralysis (n = 1). The TPE was performed for Guillain-Barré syndrome (GBS) (n = 7), myasthenia gravis (MG) (n = 3), transverse myelitis (TM) (n = 2), neuromyelitis optica (NMO) (n = 2), and systemic lupus erythematosus (SLE) cerebritis (n = 1). Twelve patients were admitted to the PICU, and mechanical ventilation was required for 10 patients. In magnetic resonance imaging (MRI) findings, abnormalities were observed in 10 cases, while the remaining five either had normal results or did not undergo MRI. Most patients required five sessions of TPE (n = 7). The median age at the initiation of TPE was 13 years. Twelve patients improved with TPE treatment, while three did not. Complications observed during and following TPE included fever (n = 5), electrolyte disturbance (n = 5), hypotension (n = 3), hypocalcemia (n = 2), bradycardia (n = 2), vomiting (n = 1), tachycardia (n = 1), eye rash (n = 1), infection (n = 1), and bleeding originating from the TPE procedure site (n = 1). In conclusion, our study underscores the significance of TPE as a therapeutic modality, emphasizing the imperative for ongoing research to fully exploit its potential across diverse medical contexts for enhancing patient care. Our findings, consistent with prior research, reveal plasma exchange's (PLEX's) wide-ranging applications and complications in neurological disorders.

Selective fluorescence turn-on detection of combination cisplatin-etoposide chemotherapy based on N-CDs/GSH-CuNCs nanoprobe.

Cisplatin (CIS) and etoposide (ETP) combination therapy is highly effective for treating various cancers. However, the potential for pharmacokinetic interactions between these drugs necessitates selective sensing methods to quantitate both CIS and ETP levels in patient's plasma. This work develops a dual fluorescence probe strategy using glutathione-capped copper nanoclusters (GSH-CuNCs) and nitrogen-doped carbon dots (N-CDs) for the simultaneous analysis of CIS and ETP. The fluorescence signal of GSH-CuNCs at 615 nm increased linearly with CIS concentration while the N-CD emission at 480 nm remained unaffected. Conversely, the N-CD fluorescence was selectively enhanced by ETP with no interference with the CuNC fluorescence. Extensive materials characterization including UV-vis, fluorescence spectroscopy, XRD, and TEM confirmed the synthesis of the nanoprobes. The sensor showed high sensitivity with limits of detection of 6.95 ng mL-1 for CIS and 7.63 ng mL-1 for ETP along with excellent selectivity against potential interferences in rabbit plasma. Method feasibility was demonstrated with application to real rabbit plasma samples. The method was further applied to estimate the pharmacokinetic parameters of CIS before and after ETP coadministration. The dual nanoprobe sensing strategy enables rapid and selective quantitation of CIS and ETP levels to facilitate therapeutic drug monitoring and optimization of combination chemotherapy regimens.

Targeting serine/glycine metabolism improves radiotherapy response in non-small cell lung cancer

BackgroundLung cancer is the most lethal cancer, and 85% of cases are classified as non-small cell lung cancer (NSCLC). Metabolic rewiring is a cancer hallmark that causes treatment resistance, and lacks insights into serine/glycine pathway adaptations upon radiotherapy.MethodsWe analyzed radiotherapy responses using mass-spectrometry-based metabolomics in NSCLC patient’s plasma and cell lines. Efficacy of serine/glycine conversion inhibitor sertraline with radiotherapy was investigated by proliferation, clonogenic and spheroid assays, and in vivo using a serine/glycine dependent NSCLC mouse model by assessment of tumor growth, metabolite and cytokine levels, and immune signatures.ResultsSerine/glycine pathway metabolites were significantly consumed in response to radiotherapy in NSCLC patients and cell models. Combining sertraline with radiotherapy impaired NSCLC proliferation, clonogenicity and stem cell self-renewal capacity. In vivo, NSCLC tumor growth was reduced solely in the sertraline plus radiotherapy combination treatment group. Tumor weights linked to systemic serine/glycine pathway metabolite levels, and were inhibited in the combination therapy group. Interestingly, combination therapy reshaped the tumor microenvironment via cytokines associated with natural killer cells, supported by eradication of immune checkpoint galectin-1 and elevated granzyme B levels.ConclusionOur findings highlight that targeting serine/glycine metabolism using sertraline restricts cancer cell recovery from radiotherapy and provides tumor control through immunomodulation in NSCLC.

Prospective Evaluation of Critically İll Patients with Therapeutic Plasma Exchange in Medical İntensive Care Unit

Aim: Therapeutic plasma exchange (TPD) is the separation of the patient's plasma for treatment purposes and the replacement of another fluid. Therapeutic plasma exchange, the use of which has expanded in recent years, is a treatment method that cleans the blood extra-corporeally and is used in many immunological and toxicological diseases. The aim of this study is to prospectively examine critical patients who are followed up in the intensive care unit and undergo therapeutic plasma exchange.
 
 Material and Method: Patients who were hospitalized in the Intensive Care Unit of Erciyes University, Faculty of Medicine, older than 18, and whose therapeutic plasma exchange (TPD) indication were included in the study. Demographic information of the patients, indication for admission to intensive care unit, and TPD indication were recorded before the procedure. Patients who were indicated for plasmapheresis were observed for side effects during the procedure.
 
 Results: A total of 31 patients were included in the study. The mean age of the patients was 46 ± 18 years. 52% of the patients were female and 48% were male. The hospitalization medyan APACHE II score (min-max: 5-40) of the patients was 20. When the patients were evaluated in terms of TPD indications in intensive care, the most common causes were 56% microangiopathic hemolytic anemia (MAHA), 13% Crimean Congo Hemorrhagic Fever (KKKA) and 10% Guillen Barre Syndrome.
 The patients were divided into two groups: living and dying. When these two groups were analyzed in terms of APACHE II Score, the mean APACHE II score of living patients was 17±7, and the mean APACHE II score of the patients who died was 25 ± 9. This difference was statistically significant (p = 0.02). The median day of the patients staying in intensive care unit was 12 (min-max: 1-86), and intensive care mortality was 48%.
 
 Conclusion: The frequency of TPD indications of patients included in the study is compatible with the literature, and TPD was applied most frequently because of MAHA. The patients were younger than the normal intensive care population. This study provides clinicians with some helpful information about the intensive care clinical course before patients undergo TPD.

Plasmapheresis in the ICU.

Therapeutic plasma exchange (TPE) is a treatment paradigm used to remove harmful molecules from the body. In short, it is a technique that employs a process that functions partially outside the body and involves the replacement of the patient's plasma. It has been used in the ICU for a number of different disease states, for some as a first-line treatment modality and for others as a type of salvage therapy. This paper provides a brief review of the principles, current applications, and potential future directions of TPE in critical care settings.

Racial Disparity in Antibody Against A rare High Prevalence Antigen; (Anti-Inb)

Abstract Introduction/Objective Introduction: Ina antigen is very rare except in Iranian and Arab populations (10.6% and 11.8%, respectively). In 1973, Badkere et al. identified this antigen in about 3% of Indians from Bombay. Inb is a very high-prevalence antigen. It is prevalent in 99.9% of Caucasians and blacks, 96% of Indians and South Asians, and 90% of Iranians and Arabs. The Indian blood group system also has two other very high prevalence antigens: INFI and INJA. Indian blood group resides in CD44 glycoprotein that binds to hyaluronate of extracellular matrix. CD44 is an adhesion molecule in lymphocytes, monocytes, and other tumor cells, but its function in RBC is unknown. Ina and Inb are sensitive to proteolytic enzyme treatments and destroyed by disulfide bond-reducing agents 2-aminoethyl isothiouronium bromide (AET) and dithiothreitol (DTT). Methods/Case Report Case study: An 11-year-old female of South-East Indian descent with a history of intractable epilepsy was admitted for surgical treatment for epilepsy. Her antibody screen was positive, and her plasma reacted with all cells in PEG AHG except for the auto control. Ficin and DTT-treated cells weakened the reactivity. Suspecting a high-frequency antibody, the patient's plasma was tested against a series of cells in the rare donor cell inventory, including O Bombay cell and Inb-cell considering the patient's ethnicity. With Inb-negative cells, the plasma tested negative. All major alloantibodies from this rare donor cell were ruled out except for anti-C, anti-E, anti-K, and anti-S due to the availability of the rare cell. Results (if a Case Study enter NA) NA Conclusion Antigen Inb has a high prevalence in all populations. The rare phenotype In(b–) has been observed in approximately 2 of 700 Indian blood donors. A patient may be advised to undergo an autologous transfusion. Fortunately, the patient's procedures were uncomplicated, so a blood transfusion was unnecessary. Awareness on the part of blood bank staff regarding the variability of the blood group phenotype and the unpredictability of Anti-Inb may aid in improving patient care. To prevent further exposure, it is recommended that patients with rare antibodies carry an Antibody ID card indicating the rare antibody they possess.Inb antigen blood donors are under represented in the general donors pool. It is recommended to develop a systematic recruitment for Inb antigen donors

Clot-Based Assay for Factor XI (FXI) Activity Is Highly Sensitive to Lupus Anticoagulant (LA) and Heparin with Potential Misdiagnosis of FXI Deficiency: The Importance of Recognizing Non-Parallelism

Introduction: Clot-based assays are employed to estimate coagulation factor activity in clinical pathology laboratories. These assays are PT- or aPTT-based and utilize dilutions of the patient's plasma in factor-deficient plasma. The curves of activity for each dilution follow a parallelism or non-parallelism pattern and the latter is typically seen in the presence of Lupus Anticoagulant (LA). Identification of this pattern is critical to avoid misdiagnosis of factor deficiency in patients who actually have an inhibitor. Materials and Methods: We observed low Factor XI (FXI) levels in patients with LA, while other factors were not affected. In order to determine the reason(s) why FXI levels are sensitive to LA, we collected 34 plasma samples from patients with dRVVT confirm ratio > 1.2, and estimated FVIII and FXI levels. FXI activity was also estimated with Dade ® Actin ® FS, a reagent that is not sensitive to the LA. The coefficient of variance (CV) for both FXI and FVIII levels were compared. To estimate the effects of heparin, plasma was spiked (0.1-1.0 IU/ML) and tested in the PTT, FXI, and FVIII assays. We tested with Dade ® Actin ® FS 4 known normal patients, 3 known FXI deficient patients, 20 known plasma positive for LA, and 10 with heparin. All assays were performed on a Siemens CS-5100 analyzer. Results: The results show that FXI is highly sensitive to LA, with non-parallelism and high CV, not observed with FVIII activity. As expected, FXI levels were not affected when LA-insensitive Dade ® Actin ® FS was used. Heparin (0.3-0.7 IU/ML) also showed non-parallelism in FXI activity, but not for FVIII. Only the highest dose of heparin (1.0 IU/ML) affected FVIII levels. Notably, the sensitivity of FXI activity to LA and heparin was explained by a few dilutions of the patient's plasma (5X) in the FXI assay, compared to other coagulation factors (20X). Of note, less diluted plasma is required for FXI activity because relatively higher levels of FXI is required to sustain and produce clot in the FXI-deficient plasma. Conclusion: This simple, yet not recognized explanation based on a literature search, is helpful to increase awareness of this analytical variable. It is also important to avoid misdiagnosis of FXI deficiency in patients with LA.

NAMPT mediates PDGF-induced pulmonary arterial smooth muscle cell proliferation by TLR4/NF-κB/PLK4 signaling pathway

Nicotinamide phosphoribosyltransferase (NAMPT), a pleiotropic protein, promotes the proliferation and migration of pulmonary artery smooth muscle cells (PASMCs), which is associated with the genesis and progression of pulmonary arterial hypertension (PAH). NAMPT is highly increased in PAH patient's plasma and highly relevant to PAH severity. The mRNA and protein levels of NAMPT are elevated in PAH animal models. However, the underlying molecular mechanisms how NAMPT mediated platelet-derived growth factor (PDGF)-induced PASMCs proliferation are still unclear. The present study aimed to address these issues. Primary cultured PASMCs were attained from male Sprague-Dawley (SD) rats. Western blotting, RT-PCR, ELISA, cell transfection, Cell Counting Kit-8 (CCK-8) and EdU incorporation assays were used in the experiments. We showed that PDGF upregulated NAMPT expression through the activation of signal transducers and activators of transcription 5 (STAT5), and elevated extracellular NAMPT further promoted the activation of NF-κB through Toll-like receptor 4 (TLR4), which ultimately upregulated polo-like kinase 4 (PLK4) expression leading to PASMCs proliferation. Knockdown of STAT5, NAMPT or PLK4, and inhibition of TLR4 or NF-κB suppressed PDGF-induced PASMCs proliferation. Our study suggests that NAMPT plays an essential role in PDGF-induced PASMCs proliferation via TLR4/NF-κB/PLK4 pathway, suggesting that targeting NAMPT might be valuable in ameliorating pulmonary arterial hypertension.

Hidrotherapy to Reduce Plasma Glucose among Patients with Diabetes Mellitus at Rsup Fatmawati (A Case Study)

Background: Diabetes mellitus type 2 occur when there is a problem about insulin production in the body, body resistant to the insulin, or the sensitivity of body to insulin decreased. Management of diabetes mellitus type 2 is needed to prevent further complications. Hydrotherapy is a complementary therapy by using water that can reduce plasma glucose levels among patients with diabetes mellitus. Purpose: the purpose of this case study is to determine the effectiveness of hydrotherapy on reducing plasma glucose level among patients with diabetes mellitus type 2. Methods: the type of this case study is descriptive. Data collection conducted through interviews, observation, and documentation. The subjects in this study were 2 patients with diabetes mellitus type 2 from Fatmawati General Hospital. Result: after finished hydrotherapy for 3 days, the patient's plasma glucose levels decreased significantly with an average decrease in subject I was 41,3 mg/dl and subject II was 23,3 mg/dl. Conclusion: researcher recommends hydrotherapy to be carried out by patient with diabetes mellitus type 2.

Therapeutic Plasma Exchange (TPE) in pregnancy: A case report

Background: Therapeutic Plasma Exchange (TPE) is a therapeutic procedure that uses an apheresis machine to remove the patient's plasma. The main goal of TPE is to eliminate pathological mediators in plasma, such as autoantibodies, immune complexes, cryoglobulins, toxins and lipids that can cause several clinical effects in patients ranging from mild symptoms such as weakness shortness of breath to paralysis and respiratory failure. This case study aims to evaluate the effect of TPE in pregnancy with a history of Myasthenia Gravis (MG). Case Presentation: A female patient, 26 years old, 16 weeks of pregnancy, with a history of MG for 3 years and regularly consumes Mestinon. The patient’s general condition is weak, with blood pressure of 100/65 mmHg, pulse rate of 110 times/minute, body temperature of 36.5oC, and breathing with the help of a ventilator. Diagnosis of 16 weeks G2P1001 with myasthenic crisis. The clinical condition improved after undergoing TPE procedures 3 times, and the patient could breathe spontaneously. Conclusion: TPE in Myasthenia gravis crisis is highly recommended and is often used as the first choice of therapy. Various physiological changes may occur during pregnancy and may affect the effectiveness and increase the side effects of TPE. Therefore, it is necessary to do some special preparation and treatment.