Platelet Transfusion Research Articles

Proteomics of human platelet lysates and insight from animal studies on platelet protein diffusion to hippocampus upon intranasal administration.

Human platelet lysates (HPLs) from allogeneic platelet concentrates (PCs) are biomaterials, which are rich in various trophic factors, increasingly used in regenerative medicine and biotherapy. Understanding how preparation methods influence the HPL protein profile, biological function, and clinical outcomes is crucial. Our study sheds light on the proteomes and functionality of different HPLs, with the aim of advancing their scientifically grounded clinical applications. To achieve this, PCs suspended in plasma underwent three distinct processing methods, resulting in seven HPL types. We used three characterization techniques: label-free proteomics and tandem mass tag (TMT)-based quantitative proteomics, both before and after the immunodepletion of abundant plasma proteins. Bioinformatic tools assessed the proteome, and western blotting validated our quantitative proteomics data. Subsequent pre-clinical studies with fluorescent labeling and label-free proteomics were used as a proof of concept for brain diffusion. Our findings revealed 1441 proteins detected using the label-free method, 952 proteins from the TMT experiment before and after depletion, and 1114 proteins from the subsequent TMT experiment on depleted HPLs. Most detected proteins were cytoplasmic, playing key roles in catalysis, hemostasis, and immune responses. Notably, the processing methodologies significantly influenced HPL compositions, their canonical pathways, and, consequently, their functionality. Each HPL exhibited specific abundant proteins, providing valuable insight for tailored clinical applications. Immunoblotting results for selected proteins corroborated our quantitative proteomics data. The diffusion and differential effects to the hippocampus of a neuroprotective HPL administered intranasally to mice were demonstrated. This proteomics study advances our understanding of HPLs, suggesting ways to standardize and customize their production for better clinical efficacy in regenerative medicine and biotherapy. Proteomic analyses also offered objective evidence that HPPL, upon intranasal delivery, not only effectively diffuses to the hippocampus but also alters protein expression in mice, bolstering its potential as a treatment for memory impairments.

Impact of frailty on patients hospitalized with myelodysplastic syndrome: A nationwide analysis.

6569 Background: Myelodysplastic Syndrome (MDS) is a complex group of neoplasms that arises from abnormalities in the bone marrow's hematopoietic stem cells, leading to ineffective blood cell production. Frailty signifies increased vulnerability to internal and external stressors, with its impact on survival in MDS gaining recognition. We conducted a retrospective analysis to explore the impact of frailty on hospitalized MDS patients and its association with unfavorable hospital outcomes. Methods: National Inpatient Sample (NIS) 2019 and 2020 was utilized to identify the patients admitted with a primary diagnosis of MDS and had a concurrent diagnosis of Frailty. The Primary outcome was Mortality, and secondary outcomes included length of stay, total cost of hospitalization, and other adverse in-hospital outcomes. Multivariate logistic regression analysis was used to calculate the outcomes after adjusting for baseline sociodemographic characteristics. Results: A total of 17,000 patients were admitted with a primary diagnosis of MDS, among whom 4,285 (25.20%) patients had a concurrent diagnosis of Frailty. The mean age of patients with and without Frailty was 75.75 (+/-14.01) and 71.54 (+/-14.68), respectively, p<0.001. After adjusting for confounding variables, Frailty was considered an independent predictor of mortality in MDS patients (OR=1.80 (1.22-2.64); p=0.003). Patients with Frailty had a prolonged length of stay in the hospital (8.62 days(3.2-9.6) without and 11.56 days (4.6-12.1) with Frailty, P<0.001), as well as an increased total cost of hospitalization ($ 132159 (3256-23651) without and $173898 (5317-389146) with Frailty, p<0.001). Additionally, Frailty was associated with an increased likelihood of sepsis (OR=2.02 (1.33-3.06); p=0.001), acute kidney injury (OR=1.22 (1.02-1.50); p=0.04), major depressive disorder (OR=1.51 (1.19-1.91); p=0.001), and a higher association with chemotherapy (OR=3.46 (1.21-9.91); p=0.021) and palliative care (OR=2.23 (1.72-2.90); p<0.001). However, frail patients were less likely to receive blood transfusions (OR=0.73 (0.61-0.88); p=0.001), and no difference was noted in the risk of platelet transfusions (OR=0.95 (0.73-1.25); p=0.763). Conclusions: Frailty is considered an independent predictor of mortality and is associated with increased healthcare resource utilization along with other adverse in-hospital outcomes. Careful and thorough identification of frailty and its effective management is crucial for improving outcomes, reducing mortality, and enhancing the quality of life for patients with debilitating MDS. [Table: see text]

Influence of nano-clay platelet concentration on achieving a transition from write once read many (WORM) to complementary resistive switching (CRS) behaviour in organo-clay hybrid thin films for memory applications

Influence of nano-clay platelet concentration on achieving a transition from write once read many (WORM) to complementary resistive switching (CRS) behaviour in organo-clay hybrid thin films for memory applications

Eltrombopag combined with immunosuppressive therapy for pediatric severe aplastic anemia.

Severe aplastic anemia (SAA) is caused by immune-mediated destruction. Standard immunosuppressive therapy (IST) is effective but needs to be improved. The data of patients with SAA and received IST were analyzed retrospectively to conducted this historical control study. A total of 115 SAA patients (60 males; median age of 5.77 years and median follow-up time of 45 months) were enrolled in this study. The complete response rates (CRR) of the eltrombopag group at 3 and 6 months were higher than the control group (30.3% vs.8.2% at 3 months; 50.0% vs. 10.2% at 6 months). The overall response rates (ORR) showed no differences. There were significant differences in the times from G-CSF, Red blood cell transfusion, and Platelet transfusion between the two groups. No difference in overall survival (OS), event-free survival (EFS), and relapse rate between two groups. There is no variable were associated with prognosis in both groups. Addition of eltrombopag to IST confers faster hematological response and higher early hematological response in pediatric SAA patients. Addition of eltrombopag to standard immunosuppressive therapy confers faster hematological response and higher early hematological response in pediatric severe aplastic anemia patients. Eltrombopag showed reliable safety but had no impact on long-term response and prognosis. This article is a historical controlled study consisting of 115 pediatric severe aplastic anemia patients and makes up for the lack of clinical data deficient on pediatric severe aplastic anemia with TPO-RA combined with IST.

Ozone Therapy in the Integrated Treatment of Female Dogs with Mammary Cancer: Oxidative Profile and Quality of Life.

Considering the high frequency of malignant breast tumors, there is a growing search for new therapeutic strategies that control neoplastic growth and dissemination, combined with fewer adverse reactions. Therefore, this study evaluated the effects of ozone therapy in female dogs with mammary cancer undergoing chemotherapy treatment. Twenty-five canines diagnosed with malignant mammary neoplasia were divided into two groups: one treated with carboplatin alone (n = 11) and the other with carboplatin associated with ozone therapy (n = 14). Clinical and laboratory evaluations, mastectomy, analysis of the oxidative profile based on total antioxidant capacity (TAC) and serum concentrations of malondialdehyde (MDA), survival rate, and quality of life were performed. Animals in the ozone therapy group had higher concentrations of red blood cells and platelets, significantly improving the survival rate and quality of life. Furthermore, adverse reactions were less intense and frequent in this group, which was associated with an increase in TAC and a reduction in MDA. These results indicate that the combination of carboplatin and ozone therapy represents a promising complementary treatment for female dogs with mammary cancer, as it was associated with fewer adverse reactions and a better oxidative profile.

Insights on P2X7 in patients with abdominal aortic aneurysm and carotid atherosclerosis

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Ministero della Salute, Italia, Rete Cardiologica Nazionale Background Carotid atherosclerosis and abdominal aortic aneurysm (AAA) are co-morbidities [1]. P2X-purinoceptor-7 (P2X7) is expressed both in human AAA and atherosclerotic carotid plaque (CPL) and is instability-associated in CPL [2-4]. P2X7 is functionally related to miR-150 and miR-186 (two microRNA which modulate vascular cell proliferation) [5,6], and may be shed into the bloodstream in correlation with C-reactive protein increase [7]. Little is known about the possible association between AAA risk and circulating P2X7, miR-150 and miR-186 in patients with/without hemodinamically significant CPL. Purpose Our aim is exploring the possible relationship between circulating P2X7, target miRs clinical status and lesion dimensions in patients with CPL and/or AAA. Methods Male patients with AAA and/or CPL were characterized.CPL stenosis was assessed by Ecocolordoppler-TSA. Eligible cohort included 20 patients with AAA undergoing aneurysmectomy [10 with CPL stenosis ≤40% (group A), 10with CPL stenosis >40% (group B)], 10 patients with hemodinamically significant CPL and small or no AAA undergoing endarterectomy (group C) donating blood and vascular samples at surgery. Twelve healthy blood donors (group D) were enrolled as controls. P2X7 protein was evaluated by ELISA. P2X7 gene, miR-150 and miR-186 were determined by RT-qPCR. Results In group A, CPL appeared mainly localized at carotid bulb, in group B extended along branches. P2X7 gene was undetermined into serum and expressed without differences among groups in patient tissues. P2X7 protein was measurable in all serum samples and was lower in group B than in the others (p=0,0117, p=0,0009, p=0,0003 vs. group A, C, D, respectively) and in group C vs. D (p=0,0006). These data differentiated patients with hemodinamically significant CPLs with severe AAA from the other patients and all those with hemodinamically significant CPLs (irrespectively from AAA severity) from healthy individuals. In group B but not in the others, serum P2X7 was linearly associated to platelet concentration. In group C the amounts of P2X7 in CPL tissue and serum were negatively associated, whereas in group A and B the P2X7 levels in AAA tissue and serum were unrelated. The miRs were detected into both serum and tissue and not correlated among them nor with circulating P2X7 protein. The serum miR-186, but not miR-150, was differentially expressed in group A vs. B (p=0,0266) and linearly related to AAA diameter in group B (p=0.0351). P2X7 content and expressed gene (p=0,015, p= 0,023, respectively) and miR expressions (p=0,0418 for miR-186, p=0,0012 for miR-150) were more elevated in AAA vs. CPL tissues, highlighting the vascular heterogenicity. Conclusions Preliminary data suggest a role for P2X7 and miR-186 in profiling patients with hemodinamically significant CPL with/without high risk AAA, deserving further investigations.

Isohemagglutinin titration in pooled and apheresis platelets.

Platelet inventory constraints necessitate ABO-incompatible platelet transfusion. Many minimize the hemolytic impact by confirming low titre (LT) donor isohemagglutinins. This process is costly. Pathogen-reduced platelets (PRP) in platelet additive solutions (PAS) will dilute plasma and decrease high-titre isohemagglutinins (HT). We determined the proportion of HT platelets and incompatible transfusions for units suspended in plasma to reassess the need for titres following introduction of PRP/PAS. Our titre method is manual tube (1:50) dilution of platelet supernatant from apheresis or whole blood derived buffy coat pools suspended in plasma, tested with A1/B red cells. Testing included 49,058 pooled and 11,738 apheresis platelets over 4 years. The HT proportion, rate of out-of-group transfusions, and hemolytic reactions were determined. The impact of PAS dilution was estimated. Totally 60,796 platelet units were tested. Group O pooled and group B apheresis platelets had HT in 6.6% and 5.7%, respectively. Group A pooled and apheresis platelets included 2% with HT. Approximately 25% of platelets transfused were ABO-incompatible and no hemolytic reactions were reported. Based on the proportions of PAS-E and plasma for PRP platelets, plasma from each donor comprises 11 mL (6% of total volume) vs 20-257 mL in untreated pools. PAS-E will replace and dilute residual plasma by at least 50%. Rare platelet pools may demonstrate HT. PRP platelets with PAS will reduce titres and may abrogate the need for titration. A strategy of group specific transfusion or transfusion of group A PRP platelet transfusions may be a safe alternative.

Application of Platelet-rich Fibrin as a Method of Treatment for Medication-related Osteonecrosis of the Jaws in Bulgaria

Lately, medication-related osteonecrosis of the jaw (MRONJ) has emerged as a common disease due to the increasing use of antiresorptive drugs (intravenous bisphosphonates) for the treatment of oncological and osteoporotic diseases, which at an advanced stage significantly affects the quality of life of patients. Therefore, new therapies that accelerate the recovery of musculoskeletal tissue have become preferred in the treatment of such diseases in recent years. An innovative approach, which supports the healing processes is the application of autologous platelet concentrates known as platelet-rich plasma (PRP) and platelet-rich fibrin (PRF). Platelets are unique blood elements responsible for hemostasis. Activated platelets secrete a large amount of growth factors that initiate regeneration in soft tissues and bones. PRP is plasma with many more platelets than are usually found in the blood. The concentration of platelets and therefore the concentration of growth factors may be 5–10 times higher (or richer) than usual. PRF is a biological material, which has the ability to release growth factors over time. Growth factors stimulate stem cells, which improve collagen and elastin in the skin. Platelets in PRF are thought to survive better than those in PRP and thus contribute to faster recovery and formation of new tissue. Fibrin is a biological scaffold that forms when an injury occurs anywhere in the body. Platelets normally circulate in the blood and bind to the fibrin scaffold. Thus connected, they are activated and release growth factors, which are small “granules”. These growth factors begin the process of wound healing by creating new skin cells, collagen and blood vessels. The present study is related to the treatment of MRONJ with PRF. It is aimed at researching the attitudes of oral and maxillofacial surgeons in Bulgaria regarding the application of innovative medical technology such as PRF in the treatment of MRONJ. An author's questionnaire was developed with the help of which the survey was carried out. The analysis of the data shows that the interest in PRF in Bulgaria is great, but unfortunately it is rarely applied. However, respondents believe that this is a promising and innovative method in various aspects of surgery.

Evaluation of activation characteristics of a canine platelet concentrate produced by a commercial double centrifugation system

IntroductionIn veterinary medicine there are few readily available products for platelet transfusion to patients with thrombocytopenia. Commercial tabletop platelet concentrating systems have recently become available to veterinarians, primarily directed towards uses associated with regenerative medicine. These systems could potentially be used to produce fresh concentrated platelets for use in transfusion medicine. This study evaluated the concentration, activation, and sterility of a double centrifugation platelet concentrate (PC) produced by a commercial benchtop system.MethodsTen healthy dogs were studied. Whole blood was collected and mixed with ACD-A in a 1:7.6 ratio of ACD-A to whole blood. 12 mL of this mixture was processed into PC via single centrifugation, while 60 mL of the anticoagulated whole blood was processed via a commercial double centrifugation system. Both types of PC were evaluated for platelet concentration, CD62P expression with and without thrombin stimulation, and for sterility.ResultsMean platelet count in the double centrifuged PC was 863 ± 352 × 103/μL, with very low white blood cell contamination (median of 0.47 × 103 leukocyte/μL (range 0.15–2.18 × 103/μL)). The double-centrifuged PC had similar baseline activation characteristics (as determined by P-selectin expression) as the single centrifuge PC (0.76% vs. 0.72% unstimulated, 30.5% vs. 34.9% stimulated, p = 0.432).DiscussionThe benchtop PC system studied here did not cause activation of platelets during production and produced a sterile product that can be further investigated as a source of fresh platelet concentrates for transfusion purposes.

ACVIM consensus statement on the treatment of immune thrombocytopenia in dogs and cats.

Management of immune thrombocytopenia (ITP) in dogs and cats is evolving, but there are no evidence-based guidelines to assist clinicians with treatment decisions. Likewise, the overall goals for treatment of ITP have not been established. Immunosuppressive doses of glucocorticoids are the first line treatment, but optimal treatment regimens beyond glucocorticoids remain uncertain. Additional options include secondary immunosuppressive drugs such as azathioprine, modified cyclosporine, and mycophenolate mofetil, usually selected based on clinician preference. Vincristine, human IV immunoglobulin (hIVIg), and transfusion of platelet or red blood cell-containing products are often used in more severe cases. Splenectomy and thrombopoietin receptor agonists are usually reserved for refractory cases, but when and in which patient these modalities should be employed is under debate. To develop evidence-based guidelines for individualized treatment of ITP patients, we asked 20 Population Intervention Comparison Outcome (PICO) format questions. These were addressed by 17 evidence evaluators using a literature pool of 288 articles identified by a structured search strategy. Evidence evaluators, using panel-designed templates and data extraction tools, summarized evidence and created guideline recommendations. These were integrated by treatment domain chairs and then refined by iterative Delphi survey review to reach consensus on the final guidelines. In addition, 19 non-PICO questions covering scenarios in which evidence was lacking or of low quality were answered by expert opinion using iterative Delphi surveys with panelist integration and refinement. Commentary was solicited from multiple relevant professional organizations before finalizing the consensus. The rigorous consensus process identified few comparative treatment studies, highlighting many areas of ITP treatment requiring additional studies. This statement is a companion manuscript to the ACVIM Consensus Statement on the Diagnosis of Immune Thrombocytopenia in Dogs and Cats.

Real-world outcomes of newly diagnosed AML treated with venetoclax and azacitidine or low-dose cytarabine in the UK NHS

AbstractVenetoclax with azacitidine is the standard of care for patients with acute myeloid leukemia (AML) who are unfit for intensive chemotherapy; however, uncertainties remain regarding the treatment schedule, accurate prognostication, and outcomes for patients treated outside clinical trials. The option of venetoclax with low-dose cytarabine (LDAC) is also available; however, it is not clear for which patients it may be a useful alternative. Here, we report a large real-world cohort of 654 patients treated in 53 UK hospitals with either venetoclax and azacitidine (n = 587) or LDAC (n = 67). The median age was 73 years, and 59% had de novo AML. Most patients received 100 mg of venetoclax with an azole antifungal. In cycle 1, patients spent a median of 14 days in the hospital, and 85% required red cell transfusion, 59% platelet transfusion, and 63% required IV antibiotics. Supportive care requirements significantly reduced after the first cycle. Patients receiving venetoclax-azacitidine had a complete remission (CR)/CR with incomplete hematological recovery rate of 67%, day 30 and day 60 mortality of 5% and 8%, respectively, and median overall survival of 13.6 months. Mutations in NPM1, RUNX1, STAG2, and IDH2 were associated with improved survival, whereas age, secondary and therapy-related AML, +8, MECOM rearrangements, complex karyotype, ASXL1, and KIT mutations were associated with poorer survival. Prognostic systems derived specifically for patients treated with venetoclax-azacitidine performed better than the European LeukemiaNet and Medical Research Council classifications; however, improved risk classifications are still required. In the 149 patients with NPM1 mutated AML, outcomes were similar for those treated with venetoclax-azacitidine and venetoclax-LDAC.

Analysis And Reason For Discard Of Blood Products: A Retrospective Study In A Tertiary Care Hospital Blood Bank From Parul Sevashram Hospital, Vadodara.

Background: A life-saving procedure is a blood transfusion, but there is often a shortage in blood supply due to various factors. Despite the enormous advancements in medical research, there is still no substitute for blood, making blood transfusions a crucial component of contemporary healthcare. The study aimed to evaluate the discard reasons for blood components, particularly Fresh Frozen Plasma, Platelet Concentration, and Red Cell Concentration and to suggest possible strategies to reduce wastage. Methods: The Retrospective analysis of discarded blood components was carried out from July, 1st 2023 to December 31st 2023 in the blood bank of Parul Sevashram. Data was collected using a discard register and computer data of discard available in blood bank and was analysed in SPSS software version 26.0 and Microsoft Excel. The wastage rate was calculated with a percentage of total number of units wastage against the total number of collections. Results: A total of 4990 blood component were prepared out of which 706 blood component was discarded. The total discard ratio of the study was 14.14%. Total replacement donors were 83.91% and 16.31% were voluntary donations. The discard rate for PC, RCC, and FFP was 86.30%, 6.82%, and 2.01%. HbsAg was the most common reason for the discard due to seropositivity of TTIs. Conclusion: The Most common component discarded was platelet and the reason for discard was the date of expiry due to non-utilization. Seropositivity was the reason for discarding red cell concentration and leakage was the most common reason for fresh frozen plasma. The wastage can be reduced by implementing proper strategies such as FIFO policy, avoiding Mega camps, proper staff training and wastage reduced protocol.

#1491 Management of immune thrombotic thrombocytopenic purpura without therapeutic plasma exchange

Abstract Background and Aims Immune thrombotic thrombocytopenic purpura (iTTP) is a rare, life-threatening autoimmune disorder caused by ADAMTS13 deficiency. The anti-VWF nanobody Caplacizumab is approved for iTTP treatment, reducing the need for therapeutic plasma exchange (TPE) and improving platelet recovery and survival. This study evaluates the treatment of acute iTTP with caplacizumab and immunosuppression, but without TPE, in comparison to the conventional management with TPE, caplacizumab and immunosuppression. Method All patients in this study were identified from the Austrian Thrombotic Microangiopathy Registry (ATMAR) and the German REACT-2020 TTP registry (ClinicalTrials.gov identifier: NCT04985318). A total of 42 acute iTTP episodes in 41 patients were managed with a treatment regimen aimed at avoiding first-line TPE if the platelet count increased after the first dose of 10 mg caplacizumab, and the patient's condition and organ function remained stable (TPE-free cohort). This treatment modification was implemented based on shared decision making. An extensive efficacy and safety analysis of this approach was performed, in comparison with a control group of 59 iTTP patients, receiving frontline caplacizumab treatment with TPE and immunosuppression (TPE cohort). The main outcome was time to platelet count normalization. Secondary outcomes included clinical response, exacerbation, refractoriness, and iTTP-related deaths. Results The primary outcome parameter, time to platelet count normalization, was not significantly different between TPE-free and TPE-based management (Kaplan-Meier estimator and log-rank test, Table 1 and Fig. 1). The median time to platelet count normalization was 3 days in the TPE-free cohort and 4 days in the TPE cohort. There were no significant differences in clinical response, exacerbations, refractoriness, or iTTP-related deaths. For evaluation of the short-term treatment response, both cohorts were assessed for the time to platelet count doubling. The median time to platelet count doubling was 1 day in both cohorts. Four patients in the TPE-free cohort did not immediately respond to the first caplacizumab injection and subsequently underwent TPE, after a maximum monitoring period of 40 hours. In these patients, TPE was initiated at a median of 1.5 days after the first caplacizumab dose, and TPE was performed for a median of 4.5 days. This delayed platelet response could be attributed to concomitant diseases and factors, e.g. active HIV and hepatitis B virus coinfection, active CMV infection, concomitant antiplatelet antibodies in association with an ovarian teratoma, and multiple platelet transfusions before the correct diagnosis. During overall follow-up, complications were observed in 11 patients (26.2%) in the TPE-free group and 16 patients (27.1%) in the TPE group, excluding complications of iTTP that were evaluated as outcome parameters. Serious complications occurred in 4 patients (6.8%) from the TPE cohort while on TPE, including severe systemic anaphylactic reactions with severe hypotension, generalized seizure and supraventricular tachycardia. Bleeding complications were reported without a significant difference between groups. Conclusion For the first time since the introduction of TPE in the early 1990s, the results of our study systematically challenge the absolute need for TPE and suggest a paradigm shift in acute iTTP management. In detail, our treatment approach was successfully implemented in 38 of 42 acute iTTP episodes (90.5%). We observed no significant difference in the time to platelet count normalization between patients with iTTP treated with and without TPE. The analysis of key secondary outcomes did not reveal significant differences in the proportion of patients who achieved a clinical response or experienced exacerbations, refractoriness, or TTP-related deaths. In conclusion, Caplacizumab and immunosuppression, without TPE, rapidly controlled microvascular thrombosis and achieved a sustained clinical response in iTTP.

Transient Myeloproliferative Disorder in a Neonate without Down Syndrome—A Rare Case Report and Review of the Literature

AbstractTransient myeloproliferative disorder (TMD) is a self-limiting disorder characteristically seen in neonates with Down syndrome with or without somatic mosaicism. Trisomy-21 limited to the hematopoietic lineage alone has been described; awareness of which is very important for appropriate evaluation and counseling in phenotypically normal children.We report a newborn with TMD who presented at birth with intracranial bleed secondary to thrombocytopenia. Peripheral smear showed 10% blasts and flow cytometry further revealed myeloid blasts of megakaryocytic lineage. The child had no phenotypic features of Down syndrome.Cytogenetic analysis (fluorescence in situ hybridization) and the conventional karyotyping from peripheral blood showed trisomy-21 in blast cells and the findings completely cleared with peripheral clearance of blasts. The possibility of Down syndrome with mosaicism was considered, however, repeat conventional karyotyping from peripheral blood at D36 and D60 of life was normal, suggesting the gain of chromosome 21 was restricted to the TMD clones.The child was supported with irradiated platelet transfusions and adequate hydration. Spontaneous resolution with resolution of cytopenias and peripheral clearance of blasts were noted from D10 of life. The child is neurologically normal and growing well.Very few reports of TMD in newborn babies without Down syndrome have been described in the literature. Awareness about the diagnostic entity of TMD even without Down syndrome would help in appropriate management and counseling.

Spontaneous intracerebral hemorrhage: a review of the prevalence, trigger factors, therapeutic and surgical treatment

Spontaneous intracerebral hemorrhage is the second most common subtype of stroke and is a significant cause of mortality and morbidity worldwide. Trigger factors that “accelerate” disease onset may include hypertension, excessive alcohol consumption, constant smoking, hypocholesterolemia, medications, male sex, advanced age, living in an underdeveloped country, ethnicity, chronic kidney disease, cerebral amyloid angiopathy, and microhemorrhages. Therapeutic solutions for spontaneous intracerebral hemorrhage aimed at stopping the progression of hemorrhage, reducing the clot volume of intraventricular and parenchymal hematoma, combating perihematomal edema and inflammation, rapidly reducing blood pressure, and providing hemostatic therapy with transfusion of platelets and other coagulation complexes. Clinical trials on minimally invasive methods of surgical evacuation (endoscopic surgery, stereotactic aspiration, and invasive craniopuncture) are ongoing and may provide positive results because of the shorter operation time and use of local anesthesia. Minimally invasive surgery methods can theoretically improve the outcomes of open surgery by reducing damage to collateral tissues and reducing anesthesia time; however, they cannot be a full-fledged alternative.

Biological therapy of bariatric surgery complications

In recent years, the number of performed bariatric interventions has increased significantly. Despite the high effectiveness of this method of treatment, the occurrence of complications is not uncommon. The most common complications are stapler line leaks, occurring in 1.5–2.4% of cases; anastomotic leakage after One Anastomosis Gastric Bypass – in 2.2–8% of cases. The problem with all methods is the increased duration of treatment and the need to go without food for significant periods of time, which means starting parenteral nutrition and risking malnutrition. The article demonstrates the effectiveness of biological therapy for complications of bariatric surgery in a series of clinical cases. Clinical cases of 2 patients with anastomotic leakage after One Anastomosis Gastric Bypass are described; also 2 patients with incompetent staple line after laparoscopic Sleeve Gastrectomy. PRP therapy, stromal vascular fraction (SVF) and fibrin glue were used. Platelet-rich plasma is an autologous blood serum containing high concentrations of platelets and growth factors. As a result, after 4 courses of PRP therapy, the patient with the failure of the upper third of the stapler line received an application of twocomponent fibrin glue “Kriofit” with a positive effect. In addition, positive dynamics was observed in the patient with the use of threecomponent therapy of anastomotic leakage. Based on the above facts, it can be concluded, that biological therapy demonstrates great potential value in the treatment of bariatric surgery complications such as stapler line leaks, and anastomotic leakage.

Characterization of transfusion-relevant bacteria reference strains in a lyophilized format.

Blood safety measures used by blood establishments to increase blood component safety can be validated using Transfusion-Relevant Bacterial Reference Strains (TRBRS). Ultra-cold storage conditions and manual preparation of the current TRBRS may restrict their practical use. To address this issue, the ISBT Transfusion-Transmitted Infectious Diseases Working Party's Bacterial Subgroup organized an international study to validate TRBRS in a user-friendly, lyophilised format. Two bacterial strains Klebsiella pneumoniae PEI-B-P-08 and Staphylococcus aureus PEI-B-P-63 were manufactured as lyophilised material. The lyophilised bacteria were distributed to 11 different labs worldwide to assess the robustness for enumeration, identification and determination of growth kinetics in platelet concentrates (PCs). Production of lyophilised TRBRS had no impact on the growth properties compared with the traditional format. The new format allows a direct low-quantity spiking of approximately 30 bacteria in PCs for transfusion-relevant experiments. In addition, the lyophilised bacteria exhibit long-term stability across a broad temperature range and can even be directly rehydrated in PCs without losing viability. Interlaboratory comparative study demonstrated the robustness of the new format as 100% of spiked PC exhibited growth. Lyophilised TRBRS provide a user-friendly material for transfusion-related studies. TRBRS in the new format have improved features that may lead to a more frequent use in the quality control of transfusion-related safety measures in the future.

The effect of near-infrared low-level light on the in vitro quality of platelets during storage.

Near-infrared (NIR) light has been successfully applied to improve the quality of mouse platelets during storage. Because it is suspected that the mitochondria contain the primary photon acceptor, we hypothesized that human platelets for transfusion may be affected similarly and could benefit from NIR light treatment. The optimal light dose was determined using portions of platelet concentrates (PCs) in PAS-E. A pool-and-split design was used to prepare PCs in PAS-E or plasma (n = 6). On day 1, one unit of both pairs was illuminated with 830 nm light (light-emitting diodes, 15 J/cm2). PCs were stored at 22°C and sampled regularly for analysis. Data were compared with their corresponding controls with a paired two-sided t-test. Illuminated platelets in PAS-E were less activated with significantly lower CD62P expression (day 8: 10.8 ± 1.8 vs. 12.2 ± 2.6, p < 0.05) and lower Annexin A5 binding (day 8: 11.8 ± 1.9 vs. 13.1 ± 2.4, ns). They produced significantly less lactate resulting in a higher pH (days 6-10). ATP content and mitochondrial membrane potential were not affected. Although these trends were also observed for PCs in plasma, the differences did not reach statistical significance as compared with the control group. Our study demonstrates that the glycolysis rate of human platelets can be modulated through the use of NIR, possibly through mitochondrial aerobic metabolism, but this requires confirmation. If NIR illumination can be further optimized, it may potentially become a useful tool in situations in which glycolysis and platelet activation are exacerbated.

Cancer complicated by thrombosis and thrombocytopenia: still a therapeutic dilemma

Individuals who have thrombocytopenia and cancer-associated thrombosis (CAT) are difficult to manage because they have a high risk of bleeding and recurrent thrombosis. The International Society on Thrombosis and Haemostasis guidelines for the management of thrombocytopenia in patients with CAT suggest two main approaches: either complete anticoagulation with transfusion support if necessary, or dose-modified anticoagulation while the platelet count is &lt;50×109/L. Nevertheless, rather than being based on information from randomized controlled trials (RCTs), these recommendations were based on expert consensus. Recent research from two different countries has shown how this cohort’s management and results vary widely. While the United Kingdom study, Cancer-Associated Venous Thrombosis and Thrombocytopenia, found no significant differences in bleeding or recurrent thrombosis between full dose and modified dose groups, the North American Thrombocytopenia Related Outcomes with Venous thromboembolism study demonstrated a significantly lower risk of bleeding events in those receiving modified dose anticoagulation compared to full dose, without an increased risk of recurrent VTE. Therefore, an RCT is required to assess the best course of action for patients with CAT and thrombocytopenia. To define the standard of care for the management of patients with CAT and thrombocytopenia, a full-scale trial called the START randomized trial (STrategies for Anticoagulation in patients with thRombocytopenia and cancer-associated Thrombosis) is an international, multi-site pilot study that compares the use of platelet transfusions plus higher dose anticoagulation to modified dose anticoagulation in patients with thrombocytopenia and CAT receiving anticoagulation.

"Brain-First" Total Body Retrograde Perfusion and Retrograde Cerebral Perfusion in Hemi-Arch Replacement

Objective: The purpose of this study is to compare the early outcomes of brain-first total body retrograde perfusion (Bf-TBRP) in comparison with retrograde cerebral perfusion (RCP) under moderate hypothermia circulatory arrest (MHCA) for hemi-arch replacement surgery. Methods: We analyzed the data of 88 patients who underwent hemi-arch replacement with Bf-TBRP (n = 18) or RCP (n = 70) under MHCA at West China Hospital of Sichuan University between 1 January 2020, and 31 July 2022. In-hospital mortality, neurological deficits, and other adverse events were recorded, which were evaluated with logistic regression to determine risk factors. Results: There was no significant difference between the Bf-TBRP and RCP groups in in-hospital mortality, cardiac events, neurological deficits, dialysis, gastrointestinal complications, and paralysis (p &gt; 0.05). The Bf-TBRP group was associated with significantly shorter hospital stay [Bf-TBRP: 8 d (interquartile range (IQR), 7–10) vs. RCP: 10 d (IQR, 8–13), p = 0.03] and fewer platelet transfusions [Bf-TBRP: 1.0 (IQR, 0–1.0) vs. RCP: 1.0 (IQR, 1.0–2.0), p = 0.05] than the RCP group. On multivariable logistic regression analysis, emergency surgery (p = 0.05) and surgery duration (p = 0.03) were determined to be risk factors. Conclusions: The study showed that Bf-TBRP is a safe technique for patients undergoing hemi-arch replacement with MHCA.