Therapeutic plasma exchange in Streptococcus pneumoniae-associated hemolytic uremic syndrome: a case report

Streptococcus pneumoniae-associated hemolytic uremic syndrome (pHUS) is an atypical form of HUS associated with microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. Although less common than diarrhea-associated HUS, incidence appears to be increasing. We report a case of a child with pHUS who underwent a course of therapeutic plasma exchange (TPE) and had complete recovery. This report adds to the existing literature supporting TPE in cases of pHUS.     

Immune response in patients with newly diagnosed glioblastoma multiforme treated with intranodal autologous tumor lysate-dendritic cell vaccination after radiation chemotherapy

Patients with glioblastoma multiforme (GBM) are profoundly immunosuppressed and may benefit from restoration of an antitumor immune response in combination with conventional radiation therapy and temozolomide (TMZ). The optimal strategies to evaluate clinically relevant immune responses to treatment have yet to be determined. The primary objective of our study was to determine immunologic response to cervical intranodal vaccination with autologous tumor lysate-loaded dendritic cells (DCs) in patients with GBM after radiation therapy and TMZ. We used a novel hierarchical clustering analysis of immune parameters measured before and after vaccination. Secondary objectives were to assess treatment feasibility and to correlate immune response with progression-free survival (PFS) and overall survival. Ten eligible patients received vaccination. Tumor-specific cytotoxic T-cell response measured after vaccination was enhanced for the precursor frequency of CD4+ T and CD4+ interferon γ-producing cells. Hierarchical clustering analysis of multiple functional outcomes discerned 2 groups of patients according to their immune response, and additionally showed that patients in the top quintile for at least one immune function parameter had improved survival. There were no serious adverse events related to DC vaccination. All patients were alive at 6 months after diagnosis and the 6-month PFS was 90%. The median PFS was 9.5 months and overall survival was 28 months. In patients with GBM, immune therapy with DC vaccination after radiation and TMZ resulted in tumor-specific immune responses that were associated with prolonged survival. Our data suggest that DC vaccination in combination with radiation and chemotherapy in patients with GBM is feasible, safe, and may induce tumor-specific immune responses.     

Stored red blood cell viability is maintained after treatment with a second-generation S-303 pathogen inactivation process

BACKGROUND: Transfusion‐transmitted infections and immunologic effects of viable residual lymphocytes remain a concern in red blood cell (RBC) transfusion. Pathogen reduction technologies for RBC components are under development to further improve transfusion safety. S‐303 is a frangible anchor‐linker‐effector with labile alkylating activity and a robust pathogen reduction profile. This study characterized the viability of RBCs prepared with a second‐generation S‐303 process and stored for 35 days. STUDY DESIGN AND METHODS: This was a two‐center, single‐blind randomized, controlled, crossover study in 27 healthy subjects. S‐303 (test) or control RBCs were prepared in random sequence and stored for 35 days, at which time an aliquot of radiolabeled RBCs was transfused. The 24‐hour recovery, RBC life span, and in vitro metabolic and viability variables were analyzed. RESULTS: The mean 24‐hour RBC recovery and hemolysis of test RBCs were similar to control RBCs and were consistent with the Food and Drug Administration (FDA) guidance for RBC viability. The mean differences in life span and median life span (T₅₀) of circulating test RBCs were 13.7 and 6.8 days, while the mean difference in the area under the curve of surviving RBCs was 1.38%, in favor of control RBCs. There were no clinically relevant abnormal laboratory values after the infusion of test RBCs. All crossmatch assays of autologous S‐303 RBCs were nonreactive. CONCLUSIONS: RBCs prepared using the S‐303 pathogen inactivation process were physiologically and metabolically suitable for transfusion after 35 days of storage, met the FDA guidance criteria for 24‐hour recovery, and did not induce antibody formation.     

Transfusion reaction reporting in the era of hemovigilance: where form meets function

BACKGROUND: Transfusion services rely on transfusion reaction reporting to provide patient care and protect the blood supply. By voluntary participation in the Hemovigilance Module of the Biovigilance Component of the National Healthcare Safety Network, health care facilities have an opportunity to share institutional transfusion reaction data nationally. An optimally designed reporting form is a critical part of reaction reporting. STUDY DESIGN AND METHODS: All reports of transfusion reactions from 2006 to 2009 were analyzed to evaluate the frequency of reported signs and symptoms and the ability of our reporting form to capture this information. A total of 400 reactions with 879 reported signs and symptoms were reviewed. We then redesigned our reporting form to facilitate participation in hemovigilance reporting and capture with the check‐box option at least 90% of historically reported signs and symptoms and all those reported in at least 2% of reactions. RESULTS: Our original reporting form failed to capture 10 of 32 (31%) signs and symptoms present on the hemovigilance reporting tool. Although our original reporting form contained 27 check‐box options, these captured only 657 (74.8%) of reported signs and symptoms. Our redesigned form captures all hemovigilance signs and symptoms. Based on our retrospective review, the new form would also capture up to 95% of previously reported signs and symptoms using the check‐box option. CONCLUSION: We believe that this study presents an evidence‐based approach to the improvement of the transfusion reaction reporting form, which may be attractive for hospitals considering participation in the hemovigilance program.     

Viability does not necessarily reflect the hematopoietic progenitor cell potency of a cord blood unit: results of an interlaboratory exercise

BACKGROUND: Clinical transplant outcome with umbilical cord blood (UCB) as source of hematopoietic progenitor cells (HPCs) is, among other factors, determined by the total number of viable nucleated cells and/or CD34+ cells in the unit. Quantitative and qualitative losses by processing and cryopreservation and by thawing and washing before transfusion may occur, however. Another reason for a discrepancy between the number of cells in the unit released by the cord blood bank and found in the transplant center may be technical differences in cell counting methods between the two sites. STUDY DESIGN AND METHODS: With the collaborative group for Biomedical Excellence for Safer Transfusion (BEST), an interlaboratory exercise was conducted among nine sites for thawed UCB variables: total nucleated cells, CD34+ cells, viability, and HPC cultures. Three frozen UCB samples were shipped, with instructions for thawing, counting, and HPC plating. RESULTS: Unexpectedly samples arrived at all nine receiving centers without detectable hematopoietic progenitor colony-forming cells. Nevertheless, wide interlaboratory ranges for viability were obtained. The proportion of viable cells was found higher with manual methods, but all viability assays used in the study overestimated functional progenitor cells. CONCLUSIONS: The results underscore the complexity of evaluation of frozen-thawed cord blood cells and the need for standardization of assessment.     

幽门螺杆菌研究现状及共识

1幽门螺杆菌的研究现状 1.1幽门螺杆菌的微生物学和流行病学目前发现幽门螺杆菌(Helicobacter pylori,Hp)是基因多态性较强的细菌.目前研究的重点主要是Hp的cag致病岛、vacA基因、尿素酶A基因、鞭毛素A基因、粘附素基因及耐药基因,以期明确Hp的致病性、进而达到免疫防治或减少Hp耐药性的产生,提高Hp根除疗效的目的.