The Effects of High Particulate Matter Levels on Platelet Recovery in Patients Receiving Prophylactic Platelet Transfusion

Sasinee Hantrakool,1 Maitree Sriwichai,2 Banphot Shaengkhamnang,2 Nipapan Leetrakool,2 Piangrawee Niprapan,1 Sawaeng Kawichai,3 Teerachat Punnachet,1 Nonthakorn Hantrakun,1 Pokpong Piriyakhuntorn,1 Thanawat Rattanathammethee,1 Chatree Chai-Adisaksopha,1 Ekarat Rattarittamrong,1 Adisak Tantiworawit,1 Lalita Norasetthada,1 Somdet Srichairatanakool4 1Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 2Blood Bank Section, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; 3Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand; 4Department of Biochemistry, Faculty of Medicine, Chiang Mai University, Chiang Mai, ThailandCorrespondence: Chatree Chai-Adisaksopha, Division of Hematology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand, Tel +66 53 935488, Email [email protected]: Exposure to fine particulate matter, particularly PM2.5, has been associated with increased platelet activation and cardiovascular risks. However, its effect on platelet recovery after transfusion remains unclear.Purpose: This study aims to assess the influence of PM2.5 exposure on platelet recovery in patients with hematologic malignancies receiving prophylactic platelet transfusions.Patients and Methods: We conducted a cross-sectional study involving 66 patients with hematologic malignancies who developed chemotherapy-induced thrombocytopenia and received prophylactic platelet transfusions between January and December 2021. A total of 191 transfusion events were analyzed. Platelet increment and corrected count increment (CCI) were measured one hour post-transfusion. Transfusions were categorized based on mean PM2.5 levels one day prior to platelet collection: the control group (< 37.5 μg/m³) and the case group (≥ 37.5 μg/m³). Multivariate analyses were used to adjust for potential confounders.Results: No significant differences were observed in platelet increment (p = 0.128) or CCI (p = 0.828) between the PM2.5 exposure groups. Correlation analyses showed no significant association between PM2.5 levels and platelet increment (r = 0.0565, p = 0.437) or CCI (r = 0.0370, p = 0.614). These findings suggest that exposure to elevated PM2.5 levels one day before donation does not significantly impair platelet recovery.Conclusion: Short-term exposure to elevated PM2.5 levels does not significantly affect platelet recovery in patients receiving prophylactic platelet transfusions. These results provide important reassurance regarding the immediate effects of air pollution on transfusion outcomes, while highlighting the need for further research into potential long-term impacts.Keywords: platelet recovery, particulate matter, prophylactic platelet transfusion, hematologic malignancies, corrected count incremen

How to discuss gene therapy for haemophilia? A patient and physician perspective

Gene therapy has the potential to revolutionise treatment for patients with haemophilia and is close to entering clinical practice. While factor concentrates have improved outcomes, individuals still face a lifetime of injections, pain, progressive joint damage, the potential for inhibitor development and impaired quality of life. Recently published studies in adeno‐associated viral (AAV) vector‐mediated gene therapy have demonstrated improvement in endogenous factor levels over sustained periods, significant reduction in annualised bleed rates, lower exogenous factor usage and thus far a positive safety profile. In making the shared decision to proceed with gene therapy for haemophilia, physicians should make it clear that research is ongoing and that there are remaining evidence gaps, such as long‐term safety profiles and duration of treatment effect. The eligibility criteria for gene therapy trials mean that key patient groups may be excluded, eg children/adolescents, those with liver or kidney dysfunction and those with a prior history of factor inhibitors or pre‐existing neutralising AAV antibodies. Gene therapy offers a life‐changing opportunity for patients to reduce their bleeding risk while also reducing or abrogating the need for exogenous factor administration. Given the expanding evidence base, both physicians and patients will need sources of clear and reliable information to be able to discuss and judge the risks and benefits of treatment

Comparison of a self-automated blood pressure measurement according to the American Heart Association recommendation versus a routine practice, a randomized-controlled trial

Abstract Background Home blood pressure monitoring is currently a gold standard for guiding an adjustment of antihypertensive medications. According to the American Heart Association (AHA), the self-automated blood pressure (BP) measurement may represent accurate home BP. However, there is a limited data in real-world practice Objective To explore the accuracy of a self-automated BP measurement in representing the actual home BP monitoring, in comparison with a single spot-arm automated BP measurement, which is routinely used in the clinical setting. Methods We conducted a single center, randomized cross-over trial. At the Cardiology clinic, hypertensive patients aged between 18 and 80 years, who were able to perform self-automated BP measurement, were included in the study. The patients were categorized into two groups using different BP measurement methods: a self-automated BP measurement according to the AHA Recommendation 2017 and a single spot-arm automated BP measurement, and then crossed over to alternative methods. All participants were instructed to rest at least 5 minutes prior to undergo BP measurement in both methods. The data of BP measurements were subsequently compared with the standard home BP monitoring. Results Overall, 190 patients underwent randomization. Mean differences of systolic blood pressure (SBP) in the self-automated AHA measurement and the single spot-arm measurement, compared with the standard home BP monitoring, were 3.57 mmHg (95% confidence interval (CI); 1.39 to 5.74 mmHg) and 9.44 mmHg (95% CI; 7.03 to11.86 mmHg), respectively (P&amp;lt;0.001) (table1). Mean differences of diastolic blood pressure (DBP) in the self-automated AHA and the single spot-arm measurements, compared with the standard home BP were −1.51 mmHg (95% CI; −2.76 to −0.25) and 2.69 mmHg (95% CI; 1.07–4.31), respectively (P&amp;lt;0.001) (table 1). White coat hypertension was detected in 7 (3.72%) of patients by AHA measurement and 17 (9.04%) by the single-spot arm measurement (P=0.008). Conclusion The self-automated BP measurement according to the AHA Recommendation 2017 was more accurate than the single spot-arm automated BP measurement in representing the actual home BP monitoring and reduced the possibility of the white coat effect. Funding Acknowledgement Type of funding sources: None. Table 1 </jats:sec