Journal of Blood & Lymph

Aim: In placenta-mediated pregnancy complications, evidence-based guidelines are based on studies with controversial results or expert opinion. In this context, the implementation of those guidelines is quite different among physicians. Our aim was to analyze the management of PMC in a real-world scenario.

Methods: From 2010 until 2016, we started the “TEAM Project” as a nested project within a working group of the Spanish Society of Thrombosis and Hemostasis (SETH : Sociedad Española de Trombosis y Hemostasia).

Results: We included 666 women with PMC, including recurrent pregnancy loss (50%), fetal death (25%), preeclampsia- eclampsia (20%), intrauterine growth restriction (5%) and placental abruption. Although a thrombophilia test was indicated in more than 80% of these patients, antiphospholipid antibodies were tested in less than 70% cases. The presence of PT20210A mutation and positive antiphospholipid antibodies were the most common findings observed. Among the 257 women with previous PMC who were assessed for thrombotic risk, 88.7% received antithrombotic prophylaxis, most frequently (46.8%) low molecular weight heparin (LMWH)+aspirin (AAS) and recurrence was observed in 14% of women.

Conclusion: This is the first observational, multicentric and multidisciplinar phase IV study analyzing the real-life clinical management of PMC and other hemostatic/thrombotic events in women from Spain and Uruguay. Our results evidence a lack of homogeneity in the management of these complications as a result of the wide discordance among the existing guidelines, as well as a need for a call to action in fetal-maternal medicine.

Background: Adolescence is a vulnerable period for the development of nutritional anemia.

Aim: To evaluate the determinants of iron deficiency, anemia, and associated factors among adolescents who performed routine blood tests in a large district in Israel during 2014.

Methods: A community-based cross-sectional observational study was conducted among adolescents aged 11-18 years, belonging to Haifa and west Galilee district of ‘Clalit’ Health Services, who routinely performed blood tests during 2014. The blood tests were investigated for iron deficiency (ferritin<20 ng/mL) or anemia (hemoglobin (HGB)<12 g/dl).

Results: Among 22310 adolescents who performed blood tests during 2014, 4116 (18.45%) were found to fulfill the inclusion criteria. 14.8% were boys, 85.2% were girls. 2964 (13.2%) adolescents were anemic, with HGB<12 g/dl, and mean HGB concentration of 11.27 g/dl. 1152 (5.16%) adolescents had hemoglobin>12 g/dl, but ferritin levels<20 ng/mL, with mean ferritin level of 14.31 ng/mL. Jews significantly had higher mean MCV values, and higher iron levels as compared to non-Jews. The average HGB levels were the lowest in the age groups of 12.5- 15.5 years, and 15.5-17 years. The severity of the anemia correlated significantly with the gender of the adolescent, females having lower HGB concentrations. Ferritin levels correlated significantly with the gender (higher in males), and age of the adolescents (lower at higher ages).

Conclusions: Iron deficiency and anemia are common in adolescents, having serious implications. Awareness to this problem should be raised, and decision makers are encouraged to find ways to prevent detect and treat it.

Chronic Myeloid Leukaemia can rarely present in essential Thrombocythaemia-like picture. Apart from the genetic defining marker (BCR-ABL fusion), these cases lack almost all typical features of CML.

Here, we highlight the response of these patients to different therapeutic approaches and to emphasize that although the proliferation is solely limited to the platelets; this group of patients did not show any response except after initiation of Tyrosine kinase inhibitors which highpoints the essentiality of excluding CML by performing BCR/ABL-1 in all cases with features of myeloproliferative neoplasms in order to avoid delayed management and adverse outcome. Apparently, many hematologists have not been persuaded to always test for BCR/ABL-1 when there are no features suggesting CML.

Unlike what was previously reported, upon literature review, we found no significant difference in disease prognosis in this group of patients compared to classic CML, provided TKI was started early in disease course.

Background: Blood transfusion is an important therapy in the management of sickle cell disease (SCD); especially in developing countries. Transfusion aids the restoration of the oxygen carrying capacity in patients with SCD and also prevents vaso-occlusion by dilution of the Hbs in circulation. However, there is paucity of information on transfusion as a therapy in the management of SCD.

Aim and objective: This study is aimed at reviewing the available publications on transfusion as a therapy for SCD management.

Materials and methods: Relevant literatures were searched on databases including PubMed, Google Scholar, Scopus, Cochrane and standard texts on haematology and transfusion medicine. The keywords used in the search are sickle cell disease, transfusion, simple and chronic transfusion, complications of transfusion, choice of blood for transfusion and guidelines for blood transfusion. The literatures gathered were reviewed, summarized and presented in this review.

Results: Blood transfusion is a cornerstone in the management of patients with SCD. The management of SCD patients requires a multidisciplinary approach with a great deal of commitment been required from all the experts. Although, many hazards are associated with blood transfusion, it is pertinent that proper care is taken in the handling and administration of blood and blood products.

Conclusion: Transfusion therapy still remains a cornerstone in SCD management and it tends to mitigate the severity and complication associated with SCD disorders. Adequate knowledge and information is needed by experts on the importance of transfusion therapy and its modalities in SCD.

Autologus stem cell transplant (ASCT) has evolved over last 5 decades a lot. There are enormous advances in the technique right from mobilization, collection, counting of stem cells to preservation, conditioning and peritransplant care. By the end of this decade we feel necessity to explore the scope and update the details and minutes of ASCT particularly in oncology grossly as well as disease-wise. We delineate the basics of the procedure and advances till date. Also we aimed to summarise the implementation of these advances in India by analyzing the data and information in published articles. This may further help physicians to understand the complex procedure with simplicity and may guide the research workers and authors as reference tool.

Objective: This objective of the study was to compare the three commonly used apheresis instruments available for Plateletpheresis, i.e., MCS Plus, COM.TEC and Amicus in terms of their Pre and Post donor CBC variables, instrument efficacy and product variables. Methodology: Donors undergoing Plateletpheresis are categorized into three groups. Sixty donors were selected according to the selection criteria of donor for Plateletpheresis by AABB. Later the procedure was performed on MCS Plus, Amicus and COM.TEC. Twenty donors were processed with each instrument. Results: The study revealed that there is no significant difference in pre and post count of donors on CBC in all the instruments. It is observed that the blood volume processed in order to have the standard platelet yield of ≥3. 3 × 1011 is higher in the COM.TEC as compared to Amicus and MCS plus (p<0.001). The mean separation time for MCS plus is greater than COM.TEC and Amicus (p<0.001). 95% of the platelet products collected with Amicus and MCS plus, have a platelet count of >3.3 × 1011. But in COM.TEC, 100% of the products have a platelet count of >3.3 × 1011. Products collected from Amicus and COM.TEC is leucodepleted. On the contrary, the products by MCS Plus are not leucodepleted. The collection efficiency is significantly low in MCS Plus (47 ± 13.6) when compares to Amicus (64 ± 7.9) and COM.TEC (59 ± 10.5). However, the collection rate is significantly higher with Amicus (0.07 ± 0.007) followed by COM.TEC (0.06 ± 0.006) and MCS plus (0.04 ± 0.004). Conclusion: The study concludes that all kits for Plateletpheresis are very efficient for platelet collection. However, both Amicus and COM. TEC is better than MCS Plus, as they give leucodepleted platelet concentrates. Amicus supersedes all as the target platelet yield is achieved more rapidly as compared to COM.TEC and MCS plus.