Prevalence and specificities of red blood cell alloantibodies in transfused Ugandans with different diseases

Background and Objectives Alloantibody formation against red blood cell (RBC) antigens is a common complication of transfusion therapy. However, the prevalence of RBC alloimmunization is hardly known in Black Africans. In Uganda, the practice is to transfuse ABO/D compatible blood without screening for immune antibodies. The aim of this study was to determine the prevalence and specificities of RBC alloantibodies in transfused Ugandans. Materials and Methods Using a cross‐sectional design, transfused patients at Mulago Hospital in Kampala, Uganda were investigated. Demographic characteristics and transfusion histories were recorded. EDTA blood samples were obtained from consenting patients and RBC alloimmunization was demonstrated using immunohaematological tests. Results A total of 214 transfused patients (mean age, 30·3 years; F/M ratio, 1·0) were investigated. Thirteen patients (6·1%) possessed RBC alloantibodies whose specificities were six anti‐E; three anti‐S; one each of anti‐D, ‐K and ‐Le^a; and two samples were pan‐reactive. Eleven (84·6%) of the alloimmunized patients had experienced up to 10 transfusion episodes. The number of units of blood transfused and the transfusion episodes were significantly associated with the RBC alloimmunization rate (P = 0·01). Conclusions The prevalence of RBC alloimmunization in transfused Ugandans was 6·1% and was associated with the number of donor exposures. This immunization rate is similar to that observed in transfused Caucasians despite differences in RBC antigen distributions. Patients with malaria were less likely to develop RBC alloantibodies. Alloantibodies were mainly against E and S antigens. We recommend the introduction of pretransfusion antibody tests in Uganda depending on the recipient’s diagnosis.     

Red blood cell transfusions are associated with HLA class I but not H‐Y alloantibodies in children with sickle cell disease

Blood transfusions can induce alloantibodies to antigens on red blood cells (RBCs), white blood cells and platelets, with these alloantibodies affecting transfusion and transplantation. While transfusion‐related alloimmunization against RBC antigens and human leucocyte antigens (HLA) have been studied, transfusion‐related alloimmunization to minor histocompatibility antigens (mHA), such as H‐Y antigens, has not been clinically characterized. We conducted a cross‐sectional study of 114 children with sickle cell disease (SCD) and tested for antibodies to 5 H‐Y antigens and to HLA class I and class II. Few patients had H‐Y antibodies, with no significant differences in the prevalence of any H‐Y antibody observed among transfused females (7%), transfused males (6%) and never transfused females (4%). In contrast, HLA class I, but not HLA class II, antibodies were more prevalent among transfused than never transfused patients (class I: 33% vs. 13%, P = 0·046; class II: 7% vs. 8%, P = 0·67). Among transfused patients, RBC alloantibody history but not amount of transfusion exposure was associated with a high (>25%) HLA class I panel reactive antibody (Odds ratio 6·8, 95% confidence interval 2·1–22·3). These results are consistent with immunological responder and non‐responder phenotypes, wherein a subset of patients with SCD may be at higher risk for transfusion‐related alloimmunization.     

The risks of red cell transfusion for hip fracture surgery in the elderly

Background and Objectives The benefits and indications for blood transfusion among surgical patients are controversial. There is evidence which suggests that blood transfusion is associated with poor clinical outcomes and risks of infection, but there are few data in the elderly population. Materials and Methods Data were collected on haemoglobin concentrations and transfusions in 919 patients undergoing hip fracture repair at a university hospital over a 2‐year period. 28‐day and 180‐day mortality were specified as primary outcomes. A composite infection outcome (chest infections, urinary tract infections and wound infections) was the main secondary outcome. Preoperative, operative and/or postoperative transfusions were the main exposure variable. Regression analyses were used to explore the associations between transfusion and outcomes, adjusting for pre‐defined preoperative variables. Results 300 patients (32·6%) were transfused at least once during their admission. There was no evidence of a significant difference in either 28‐day survival or 180‐day survival between transfused and non‐transfused hip fracture patients. The transfused group had higher adjusted composite infection rate (HR, 1·91; 95% CI, 1·41–2·59, P < 0·001) and prolonged length of stay in hospital than the non‐transfused group (HR, 1·15; 95% CI, 1·07, 1·23, P < 0·001). Anaemia at the time of admission, extra capsular fracture and using walking aids in an indoor setting were preoperative variables, which predicted the need for transfusion. Conclusion Among an elderly population with hip fracture, blood transfusion was not associated with changes in mortality, but was associated with an increased rate of postoperative infection. These data add to the wider literature about adverse clinical outcomes in patients receiving blood transfusions and emphasises the need for prospective trials to evaluate the role of transfusion in the elderly.     

Blood utilisation and transfusion reactions in adult patients transfused with conventional or pathogen-reduced platelets

Pathogen-reduced (PR) platelets are routinely used in many countries. Some studies reported changes in platelet and red blood cell (RBC) transfusion requirements in patients who received PR platelets when compared to conventional (CONV) platelets. Over a 28-month period we retrospectively analysed platelet utilisation, RBC transfusion trends, and transfusion reaction rates data from all transfused adult patients transfused at the Yale-New Haven Hospital, New Haven, CT, USA. We determined the number of RBC and platelet components administered between 2 and 24, 48, 72 or 96 h. A total of 3767 patients received 21 907 platelet components (CONV = 8912; PR = 12 995); 1,087 patients received only CONV platelets (1578 components) and 1,466 patients received only PR platelets (2604 components). The number of subsequently transfused platelet components was slightly higher following PR platelet components (P < 0·05); however, fewer RBCs were transfused following PR platelet administration (P < 0·05). The mean time-to-next platelet component transfusion was slightly shorter following PR platelet transfusion (P = 0·002). The rate of non-septic transfusion reactions did not differ (all P > 0·05). Septic transfusion reactions (N = 5) were seen only after CONV platelet transfusions (P = 0·011). These results provide evidence for comparable clinical efficacy of PR and CONV platelets. PR platelets eliminated septic transfusion reactions without increased risk of other types of transfusions with only slight increase in platelet utilisation.     

Prevalence and risk factors for red blood cell alloimmunization in 175 children with sickle cell disease in a French university hospital reference centre

Patients with sickle cell disease (SCD) show a high prevalence of red blood cell (RBC) alloimmunization, but few studies have focused on children. We aimed to study the prevalence and risk factors of RBC alloimmunization in SCD children. We retrospectively analysed the medical and transfusion files for 245 SCD children hospitalized in our centre in 2014 and included 175 patients who had received at least one RBC unit in their lifetime. The main clinical and immuno‐haematological characteristics of alloimmunized and non‐alloimmunized patients were compared. The prevalence of alloimmunization was 13·7% [95% confidence interval (CI) (8·6–18·6)], and 7·4% [95% CI (3·5–11·3)] after excluding the probable irregular natural antibodies (anti‐M, anti‐Le^a, anti‐Le^b, anti‐Le^x). Main risk factors for alloimmunization were increased number of RBC units received (median of 65 vs. 10 units per patient; P = 0·01) and the presence of one or more red cell autoantibodies (46·2% vs. 4·7%; P < 0·0001). The alloimmunization rate was higher for episodically transfused than chronically transfused patients (1·43 vs. 0·24/100 units received; P < 0·001). The presence of red cell autoantibodies appears to be a major risk factor for alloimmunization in SCD children and could justify specific transfusion guidelines.     

Transfusion practice and complications after laparotomy--an observational analysis of a randomized clinical trial

Background Transfusion of allogeneic red blood cells (RBC) may be associated with side effects. This study aimed to assess whether an association could be detected between transfusion practice and the occurrence of complications after laparotomy. Study design and methods This study is an observational analysis of data from a randomized trial in 1400 patients who underwent laparotomy. A subgroup of 224 transfused patients with an intraoperative blood loss ≥200 ml were included in the analysis. Logistic regression analysis was used to investigate risk factors for postoperative complications. The ratio of intraoperative RBC transfusion to blood loss was computed, and patients grouped by the median into a liberal transfusion practice (ratio equal to or above the median) and a restrictive transfusion practice group (ratio below the median). Results Surgical site infection occurred in 27% of patients in the liberal group vs. 20% of patients in the restrictive group with an OR of 1·5 [95% CI: 0·8–2·9] (P = 0·18) and an OR of 1·2 [95% CI: 0·5–2·9] (P = 0·73) when adjusting for known confounding variables. Pneumonia occurred in 14% vs. 8% in the liberal and restrictive group, respectively (adjusted P = 0·07), and admission to the intensive care unit was 15% vs. 7%, respectively (adjusted P = 0·02), but no other significant differences were found. Conclusion A liberal transfusion practice was not significantly associated with postoperative complications, but pneumonia tended to be more common in the liberal group, which was more often admitted to the intensive care unit.     

Red-blood-cell alloimmunization and number of red-blood-cell transfusions

Background Patients receiving red‐blood‐cells may form antibodies against the alloantigens expressed by red‐blood‐cells, with the risk of serious morbidity and the need for extensive phenotype‐matching in subsequent transfusions. The incidence of alloimmunization is considered variable for specific patient groups and for first time antibody formation. We therefore studied the cumulative incidence of the first formed alloantibody as a function of red‐blood‐cells exposure. Methods We performed a new‐user cohort among all previously non‐transfused non‐alloimmunized patients that received non‐extended matched (ABO and RhD) red‐blood‐cells transfusions from January 2005 to December 2009 in our university medical centre. Alloimmunization incidences were estimated by Kaplan–Meier survival‐analysis. Results A total of 3002 previously non‐transfused patients received 31 103 red‐blood‐cell units. A first time alloantibody forming event was experienced by 54 (1·8%) patients. The cumulative incidence of alloimmunization was 1·0% at 5 units, 2·4% at 10 units, 3·4% at 20 units and 6·5% at 40 units of red‐blood‐cells transfused. Conclusion The risk to develop a first red‐blood‐cells alloantibody increases up to the 40th transfusion and is similar for men and women. More data are needed to examine the risk after 40th transfusion.     

Development and validation of a model to predict platelet response to romiplostim in patients with lower‐risk myelodysplastic syndromes

Low endogenous erythropoietin levels and limited red blood cell transfusion history can predict response to erythropoiesis‐stimulating agents in anaemic patients with myelodysplastic syndromes (MDS). The relationship between endogenous thrombopoietin (THPO) levels and platelet response to romiplostim is unknown. Variables including baseline endogenous THPO levels, transfusion needs, and platelet response were analysed in a randomized trial of 250 thrombocytopenic, lower‐risk MDS patients (International Prognostic Scoring System low/intermediate‐1). A predictive scoring system was developed based on log–likelihood ratios and logistic coefficients. Patients with HI–P (haematological improvement – platelets) responses had lower mean baseline THPO levels (P = 0·0497) and were more likely to have <6 platelet units transfused in the past year (P = 0·0027), as did patients with platelet responses ≥50% of weeks on romiplostim (P = 0·001 and P = 0·0037, respectively). A model for predicting response to romiplostim was developed and validated in a separate MDS cohort (N = 72). Patients in low‐, intermediate‐, and high‐response groups had response rates of 17·4%, 29·6%, and 50·7%, respectively, for HI‐P, and 17·4%, 33·8%, and 65·2%, respectively, for ≥50% response. For thrombocytopenic patients with lower‐risk MDS, lower baseline THPO levels (<500 pg/ml) and limited platelet transfusion history predicted a greater likelihood of a subsequent platelet response to romiplostim.     

Allogeneic blood transfusion does not increase the risk of wound infection in total knee arthroplasty

Background and Objective Allogeneic blood transfusion has been reported to increase the risk of postoperative infection in arthroplasty though the results are inconclusive. Data from a previous clinical trial on antibiotic prophylaxis in knee arthroplasty were analysed to gain further insight into the relationship between wound infection and both blood transfusion and the storage time of transfused RBCs. Materials and Methods A total of 910 consecutive patients undergoing primary knee arthroplasty were prospectively followed for 12 months after surgery. The main outcome was wound infection, either superficial or deep‐tissue. Possible predictors for wound infection included the patient’s age and sex, preoperative physical status, time under leg ischaemia, postoperative fluid drainage, and the number and length of storage of transfused RBCs. Results Deep tissue infection was diagnosed in 28 (3%) patients, superficial infection in 25 (2·7%) and cellulitis in eight (0·8%) patients. Transfusion of at least one blood unit had been given to 22 (36%) of the 61 patients who later developed wound infection and 313 (36%) of those who did not (P > 0·05). Patients who developed wound infection had a significantly poorer physical status and longer time of leg ischaemia. There was no significant difference between both groups of patients in either the amount or the length of storage of transfused RBC units. Conclusion This study failed to find any association between the incidence of wound infection after knee arthroplasty and allogeneic transfusion.     

Efficacy and toxicity of a paediatric protocol in teenagers and young adults with Philadelphia chromosome negative acute lymphoblastic leukaemia: results from UKALL 2003

Despite the substantial outcome improvements achieved in paediatric acute lymphoblastic leukaemia (ALL), survival in teenage and young adult (TYA) patients has remained inferior. We report the treatment outcomes and toxicity profiles observed in TYA patients treated on the UK paediatric ALL trial, UKALL2003. UKALL2003 was a multi‐centre, prospective, randomized phase III trial, investigating treatment intensification or de‐escalation according to minimal residual disease (MRD) kinetics at the end of induction. Of 3126 patients recruited to UKALL2003, 229 (7·3%) were aged 16–24 years. These patients were significantly more likely to have high risk MRD compared to 10–15 year olds (47·9% vs. 36·6%, P = 0·004). Nonetheless, 5‐year event‐free survival for the TYA cohort (aged 16–24 years) was 72·3% [95% confidence interval (CI): 66·2–78·4] overall and 92·6% (95% CI: 85·5–99·7) for MRD low risk patients. The risk of serious adverse events was higher in patients aged ≥10 years compared to those aged 9 or younger (P < 0·0001) and novel age‐specific patterns of treatment‐related toxicity were observed. TYA patients obtain excellent outcomes with a risk‐ and response‐adapted paediatric chemotherapy protocol. Whilst those aged 10 years and older have excess toxicity compared with younger patients, the age association is specific to individual toxicities.     

Granulocyte‐reactive antibodies are associated with red blood cell alloimmunization

Granulocyte‐reactive antibodies may cause transfusion‐related acute lung injury (TRALI) and immune neutropenias. Risk factors for their acquisition other than previous alloexposition are largely unknown. In addition to the known association between human leucocyte antigen alloantibodies and red blood cell alloimmunization in selected cohorts of transfused patients, this study investigated a possible extension of this association to granulocyte‐reactive antibodies in women with a history of pregnancy. The overall prevalence of granulocyte‐reactive antibodies in 333 samples from women with a history of pregnancy (143 samples containing red cell alloantibodies) was 23·1%. The prevalence in the red cell‐alloimmunized group (32·9%) was significantly higher than in controls (15·8%, P < 0·001). This could suggest that some individuals may be strong immunological responders, forming alloantibodies more readily than others.     

Outcome of children with acute myeloid leukaemia (AML) experiencing primary induction failure in the AIEOP AML 2002/01 clinical trial

Paediatric patients with acute myeloid leukaemia (AML) who fail induction due to primary resistance to chemotherapy account for a significant proportion of cases and have a particularly dismal prognosis. We report the clinical and biological data, and final outcome of 48 paediatric patients with primary‐resistant AML enrolled in the Associazione Italiana di Ematologia e Oncologia Pediatrica AML 2002/01 clinical trial. These patients had a significantly higher white blood cell count at diagnosis compared to other AML patients. Cytogenetic and molecular features did not differ between patients with primary induction failure and patients allocated to the high‐risk group. For the whole patient population, the probability of overall survival, event‐free survival (EFS) and disease‐free survival (DFS) was 21·8% ± 6·2, 20·4% ± 5·9, and 49·5% ± 11·3, respectively. Twenty‐eight (58%) patients received haematopoietic stem cell transplantation (HSCT); 3 were autologous and 25 were allogeneic. Patients who underwent HSCT had improved EFS (31·2% vs. 5%, P < 0·0001). Only one of the 20 patients who did not receive HSCT is alive and disease free. The 19 patients in complete remission at time of HSCT showed significantly better DFS than the 9 with active disease (46% vs. 0%, P = 0·02). This study represents one of the largest series with long‐term follow up of paediatric AML patients with primary refractory disease. Children who underwent transplantation had an encouraging long‐term outcome. Disease recurrence remains the major cause of treatment failure; a better understanding of the disease biology is desirable to develop more effective treatment strategies.     

Transfusion‐related mortality after primary hip arthroplasty – an analysis of mechanisms and confounders

Background and Objectives Bleeding and postoperative anaemia after total hip arthroplasty (THA) may trigger transfusion of red blood cells (RBC). However, large observational studies have reported associations between RBC transfusion and increased postoperative morbidity and mortality. As major bleeding or severe postoperative anaemia is intrinsically linked with RBC transfusion, direct causality between transfusion and adverse outcomes remains unclear. This study aimed to identify possible relations between RBC transfusion, severe bleeding or anaemia and mortality in all patients who died < 90 days after THA in Denmark in 2008. Materials and Methods Nationwide review of patient records. Cases of adverse transfusion events, infections following transfusion, severe perioperative bleeding or anaemia and possible causal relations to mortality were identified by two independent reviewers. Results Of 6932 THA patients, 45 (0·6%) were transfused within 30 days and died < 90 days from surgery. Three patients (7%) died from causes possibly related to either severe anaemia, major bleeding alone or major bleeding with transfusion‐related acute lung injury, while five (11%) died from infections occurring after RBC transfusion. Mortality in the remaining 37 patients (82%) was of unknown cause (nine patients) or related to patient or surgical factors (28 patients). Conclusion Transfusion‐related mortality after THA included cases of major perioperative bleeding or severe postoperative anaemia with delayed RBC transfusion in addition to possible complications to RBC transfusion per se. Future studies should account for pretransfusion haemoglobin and perioperative blood loss when evaluating RBC transfusion‐associated outcomes after surgery.     

The impact of donor type and ABO incompatibility on transfusion requirements after nonmyeloablative haematopoietic cell transplantation

We retrospectively analyzed transfusion requirements within the first 100 d among allogeneic haematopoietic cell transplantation (HCT) recipients with haematological malignancies given either myeloablative (n = 1353) or nonmyeloablative conditioning (n = 503). We confirmed that myeloablative recipients required more platelet and red blood cell (RBC) transfusions than nonmyeloablative recipients (P < 0·0001 for both). Myeloablative patients given peripheral blood stem cells required less platelet transfusions (P < 0·0001) than those given marrow while RBC transfusion requirements did not differ significantly. Subsequent analyses were restricted to nonmyeloablative recipients. Platelet and RBC transfusions were less frequent among related compared to unrelated recipients (P < 0·0001 for both), with comparable median numbers of transfused units. Major/bidirectionally ABO‐mismatched recipients required more RBC transfusions than ABO‐matched recipients (P = 0·006). Rates of graft rejection/failure, grades II–IV acute and chronic graft‐versus‐host‐disease (GVHD), 2‐year relapse, 3‐year survivals and non‐relapse mortality were comparable among ABO‐matched, minor‐mismatched, and major/bidirectionally mismatched recipients (P = 0·93, 0·72, 0·57, 0·36, 0·17 and 0·79, respectively). Times to disappearance of anti‐donor IgG and IgM isohemagglutinins among major/bidirectionally ABO‐mismatched recipients were affected by magnitude of pre‐HCT titres (P < 0·001 for both) but not GVHD (P = 0·71 and 0·78, respectively). In conclusion, nonmyeloablative recipients required fewer platelet and RBC transfusions and among them, both unrelated and major/bidirectionally ABO‐mismatched recipients required more RBC transfusions. ABO incompatibility did not affect nonmyeloablative HCT outcomes.     

Nodular lymphocyte predominant Hodgkin lymphoma in USA between 2000 and 2014: an updated analysis based on the SEER data

Plasma transfusions may result in transfusion reactions. We used the International Surveillance of Transfusion‐Associated Reactions and Events (ISTARE) database, containing yearly reported national annual aggregate data on transfusion reactions from participating countries, to investigate risks of plasma transfusion reactions and compare transfusion reaction risks for different plasma types. We calculated risks for plasma transfusion reactions and compared transfusion reaction risks between plasma types using random effects regression on repeated measures. The ISTARE database contains data from 23 countries, reporting units issued and/or transfused and transfusion reactions observed for some portion of 7 years (2006–2012). Interquartile ranges (IQRs) of plasma transfusion reaction risks were: allergic reactions (5·6–72·2 reactions/10⁵ units transfused); febrile non‐haemolytic transfusion reactions (0–9·1); transfusion‐associated circulatory overload (0–1·9); transfusion related acute lung injury (TRALI) (0–1·2); and hypotensive reactions (0–0·6). Apheresis plasma was associated with more allergic reactions [odds ratio (OR) = 1·29 (95% confidence interval: 1·19–1·40)] and hypotensive reactions [OR = 2·17 (1·38–3·41)] than whole blood‐derived plasma. Pathogen‐inactivated plasma was associated with fewer transfusion reactions than untreated plasma.     

The PROTON study: profiles of blood product transfusion recipients in the Netherlands

Background Transfusion recipient data are needed for correct estimation of cost‐effectiveness in terms of recipient outcomes after transfusion. Also, such data are essential for monitoring blood use, estimation of future blood use and benchmarking. Study Design and Methods A sample of 20 of 93 Dutch hospitals was selected. Datasets containing all blood product transfusions between 1996 and 2006 were extracted from hospital blood bank computer systems, containing transfusion date, blood product type and recipient characteristics such as gender, address, date of birth. The datasets were appended and matched to national hospitalization datasets including primary discharge diagnoses (ICD‐9). Using these data, we estimated distributions of blood recipient characteristics in the Netherlands. Results The dataset contains information on 290 043 patients who received 2 405 012 blood products (1 720 075 RBC, 443 697 FFP, 241 240 PLT) from 1996 to 2006. This is 28% of total blood use in the Netherlands during this period. Comparable diagnosis and age distributions of all hospitalizations indicate included hospitals to be representative, per hospital category, for the Netherlands. Of all red blood cells (RBC), fresh‐frozen plasma (FFP) and platelets (PLT), respectively 1·7%, 2·5% and 4·5% were transfused to neonates. Recipients of 65 years or older received 57·6% of RBC, 41·4% of FFP and 29·0% of PLT. Most of the blood products were transfused to patients with diseases of the circulary system (25·1%) or neoplasms (22·0%). Conclusion Transfusion data from a limited sample of hospitals can be used to estimate national distributions of blood recipient characteristics.     

Benefit of transfusion-related acute lung injury risk-minimization measures--German haemovigilance data (2006-2010)

Objective Based on the frequency of immune‐mediated and non‐immune‐mediated transfusion‐related acute lung injury (TRALI), the effect of risk‐minimization measures was evaluated during a period of 5 years (2006–2010). Risk‐minimization measures were implemented in 2008/2009, consisting of exclusion of female donors with a history of pregnancy or exclusion of female donors with human leucocyte antigen (HLA)/human neutrophil alloantigen (HNA) antibodies. Methods TRALI was confirmed according to the criteria of the International Haemovigilance Network. Based upon the results of donor testing of white‐blood‐cell antibodies (WBC‐Ab) against HLA or HNAs, confirmed cases were classified as immune‐ or non‐immune‐mediated TRALI. Reporting rates were calculated on the basis of the annually transfused blood components, and pre‐ and post‐implementation periods were compared. Results In total, 60 immune‐mediated (75%) and 20 non‐immune‐mediated (25%) TRALI reactions were confirmed. A total of 68 (64 women and four men) donors were involved: seven red‐blood‐cell concentrates donors (13%), six platelet concentrate donors (10%), and 48 fresh frozen plasma (FFP) donors (77%). The reporting rate of immune‐mediated TRALI caused by FFP decreased continuously; from 12·71 per million units in 2006/2007 to 6·81 per million units in 2008/2009 and no case in 2010. Conclusion The comparison of the pre‐ and the post‐implementation period demonstrated a significantly reduced risk of TRALI events comparing 2006/2007 with 2010 (P‐value: < 0·01). Furthermore, no case of TRALI‐induced fatality occurred after the implementation of risk‐minimization measures.     

云南省保山市全球基金疟疾项目执行效果评价

目的通过对保山市全球基金疟疾项目执行效果进行分析评价,为今后深入持久地开展全市疟疾防治提供依据。方法对保山市2003~2009年疟疾疫情和全球基金疟疾项目执行情况进行统计与分析。结果保山市2003~2009年共报告确诊疟疾病例16 743例,占总报告传染病总数的34.77%。其中间日疟11 833例,恶性疟3 864例,混合感染118例,未分型928例,死亡32例。全球基金疟疾项目的实施使确诊疟疾病例从2002年的2 013例下降到2009年的981例,下降率为51.27%;发病率从2002年的84.08/10万下降到2009年的39.51/10万,下降率为53.01%;内源性疟疾病例从2002年的80例下降到2009年的18例,下降率为77.50%。结论全球基金疟疾项目在保山市的疟疾防治中处于十分重要的地位,对疟疾疫情的控制,专业人员素质的提升,群众疟疾防治知晓率的提高和防治依从性的增加等多个方面发挥了显著的作用。     

Negative CD19 expression is associated with inferior relapse-free survival in children with RUNX1-RUNX1T1–positive acute myeloid leukaemia: results from the Japanese Paediatric Leukaemia/Lymphoma Study Group AML-05 study

We performed a retrospective analysis of leukaemic surface antigen expression and genomic data from a total of 100 RUNX1-RUNX1T1–positive paediatric acute myeloid leukaemia (AML) patients enrolled in the Japanese Paediatric Leukaemia/Lymphoma Study Group (JPLSG) AML-05 protocol to determine risk factors for relapse. In univariate analysis, the KIT exon 17 mutation (n = 21) and CD19 negativity (n = 59) were significant risk factors for relapse (P = 0·01). In multivariate analysis, CD19 negativity was the sole significant risk factor for relapse (hazard ratio, 3·09; 95% confidence interval, 1·26–7·59; P < 0·01), suggesting that biological differences between CD19-positive and CD19-negative RUNX1-RUNX1T1 AML patients should be investigated.     

Transfusion practices in massive haemorrhage in pre-intensive and intensive care

Background and Objectives Primary resuscitation for massive haemorrhage often occurs in emergency departments or operating theatres, with ongoing resuscitation in the intensive care unit (ICU). The aim of the study was to retrospectively review transfusion practice in the pre‐ICU phase and ICU for patients with massive haemorrhage. Materials and Methods From 1998 to 2006, we developed an electronically linked database of blood and blood product usage and laboratory data with clinical outcome. All patients who received 10 or more units of red cells and required ICU admission were included. Results Of 238 patients who required massive transfusion, 40 died early (within 24 h of massive transfusion), out of which 16 died in pre‐ICU and 24 died in ICU. Comparatively this group of patients presented in the pre‐ICU phase and on ICU admission, respectively, with coagulopathy (median international normalized ratio 1·6 and 2·1) and acidosis (median base deficit ?11·5 and ?14 mmol/l). These patients had median ratios of fresh frozen plasma (FFP) to red blood cells of 1:3·3 and 1:1·3 in the pre‐ICU and ICU phases, respectively. Severity of coagulopathy indicated by INR at ICU admission [P = 0·04; area under receiver operator curve (ROC) = 0·69] and RBC transfused (P = 0·01) in 24 h associated with mortality. Conclusions Patients who died early were coagulopathic before and on ICU admission and did not correct their coagulopathy. This study also shows that coagulopathy is associated with an increased risk of mortality. Early and aggressive correction of coagulopathy for patients presenting with coagulopathy may be effective in improving mortality.