Improved efficiency of plasmapheresis collection in Italy through licensed variations of current practice: a proposal

Background. The overall production efficiency of plasmapheresis in Italy is significantly less than that indicated by international data, but can be significantly improved by slightly increasing the amount of plasma collected for each procedure, while fully respecting the current regulations. Materials and methods. In order to compare the average plasma volumes collected by means of apheresis in Italy and other European countries, we considered data supplied by Kedrion (the only company active in Italy in the field of plasma-derived products) relating to Italy and three centres managed by Kedrion in Germany. Results. In 2014, Kedrion received about 174,000 kg of plasma collected by means of plasmapheresis in Italy, for an average unit weight including anticoagulant of 577 g, as against the approximately 97,000 kg (average unit weight including anticoagulant 783 g) produced by the three Kedrion centres in Germany. The net weight of the plasma (without anticoagulant) contained in a plasmapheresis unit of 577 g is about 520 g, whereas a maximum collected volume of 600 mL (permitted by current Italian legislation without the need for volume reintegration) would provide a plasma unit volume of 660 mL (600 mL of plasma plus about 60 mL of anticoagulant): i.e. 14% more than that currently provided by Italian Transfusion Centres. This would increase the total amount of plasma sent to Kedrion to 199,500 kg, without creating any major organisational difficulties (only a few minutes' increase in the length of the procedure) or additional costs, or increasing donor risk. Discussion. It is possible to hypothesise the following donation volumes. Women weighing 50-60 kg: 550 mL (net of anticoagulant), final unit volume about 610 mL; men, and women weighing >60 kg: 600 mL net, final unit volume about 660 mL. Using recently published data relating to the plasmapheresis centre in Verona (Italy), the cost of a litre of plasma is \u20ac 283.87 if the average unit volume (including anticoagulant) is 600 mL, and \u20ac 263.46 if it is 650 mL (i.e. a net plasma yield of 585 mL): a 7.2% cost reduction simply by increasing final unit volume by 50 mL, something that is already feasible and perfectly safe, and does not require donor volume reintegration under current Italian law

Laparoscopic surgery does not reduce the need for red blood cell transfusion after resection for colorectal tumour: a propensity score match study on 728 patients

Background: Patients with colorectal tumour often present with anaemia, and up to 60% will receive red blood cells (RBC) transfusion. Some evidence suggests a correlation between RBC transfusion and worse outcomes. Since laparoscopy minimizes intraoperative blood loss, we retrospectively investigated its role in reducing haemoglobin (Hb) drop and requirements for postoperative RBC transfusions. Methods: Patients were identified from consecutive cases undergone elective surgery for non-metastatic colorectal tumour between 2005 and 2019. Laparoscopic cases were matched 1:1 with open controls through propensity score matching (PSM). The main outcome measures were postoperative Hb drop and requirement for RBC. The secondary aim was evaluation of risk factors for postoperative RBC transfusions. Results: After application of PSM, 364 patients treated by laparoscopy were matched with 364 patients undergone open surgery. The two groups presented similar clinical and pathological characteristics, as well as comparable postoperative outcomes. 56 patients in the open group and 47 in the laparoscopic group required postoperative RBC (P = 0.395). No difference was observed in terms of mean number of RBC units (P = 0.608) or Hb drop (P = 0.129). Logistic regression analysis identified preoperative anaemia and occurrence of postoperative complications as relevant risk factors for postoperative RBC transfusion, while surgical approach did not prove statistically significant. Conclusion: Laparoscopy did not influence postoperative requirements for RBC transfusions after elective colorectal surgery. Preoperative anaemia and occurrence of postoperative complications represent the major determinants for postoperative transfusions after open as well as laparoscopic surgery

Lifestyle and dietary factors, iron status and one-carbon metabolism polymorphisms in a sample of Italian women and men attending a Transfusion Medicine Unit: a cross-sectional study

Iron (Fe) status among healthy male and female blood donors, aged 18–65 years, is estimated. General characteristics and lifestyle factors, dietary habits and major one-carbon metabolism-related polymorphisms were also investigated. An explorative cross-sectional study design was used to examine a sample of blood donors attending the Transfusion Medicine Unit of the Verona University Hospital, Italy. From April 2016 to May 2018, 499 subjects were enrolled (255 men, 244 women, 155 of whom of childbearing age). Major clinical characteristics including lifestyle, dietary habits and Fe status were analysed. The MTHFR 677C > T, cSHMT 1420C > T, DHFR 19bp ins/del and RFC1 80G > A polymorphisms were also assayed. Mean plasma concentrations of Fe and ferritin were 16·6 µmol/l (95 % CI 16·0, 17·2) and 33·8 µg/l (95 % CI 31·5, 36·2), respectively. Adequate plasma Fe concentrations (> 10·74 µmol/l) were detected in 84·3 % and adequate ferritin concentrations (20–200 µg/l) was found in 72·5 % of the whole cohort. Among the folate-related polymorphisms analysed, carriers of the DHFR 19bp del/del mutant allele showed lower ferritin concentration when compared with DHFR 19bp ins/del genotypes. In a sample of Italian healthy blood donors, adequate plasma concentrations of Fe and ferritin were reached in a large proportion of subjects. The relationship of Fe status with lifestyle factors and folate-related polymorphisms requires more investigation to clarify further gene–nutrient interactions between folate and Fe metabolism

Subcutaneous bolus injection of deferoxamine in adult patients affected by onco-hematologic diseases and iron overload

Background and Objective. Chelation therapy is often necessary for patients who undergo chronic transfusion therapy for myelodysplastic syndromes. In these patients, deferoxamine, the most widely used chelating agent, has been reported to be effective in reducing the iron burden and the transfusion requirement. Unfortunately, compliance with the drug, that is usually administered by slow subcutaneous infusion via a battery operated pump, is often poor, especially in elderly patients

Increase of poly(ADP-ribose) polymerase mRNA levels during TPA-induced differentiation of human lymphocytes

AbstractThe non-mitogenic stimulation of human peripheral blood mononuclear cells (PBMC) with low concentrations of the phorbol ester 12-O-tetradecanoylphorbol 13-acatate (TPA) caused a progressive increase in the percent fraction of the cells that were positive for the early activating antigen CD69. At the same time, it caused a progressive increase in the steady-state levels of poly(ADP-ribose) polymerase (pADPRP) transcripts. A further increase in TPA concentration, while inducing the maximal expression of the levels of CD69 activating surface antigen, both in the presence or in the absence of proliferative activity, did not evoke any additional hightening of pADPRP mRNA levels. Time course of PBMC stimulation with a non-mitogenic dose or TPA showed an early increase in the accumulation of pADPRP mRNA, which changed at 8-16 h. and remained high for several days thereafter. On the basis of these data, we suggest flat the increase in pADPRP mRNA may be associated with the commitment of human lymphocytes from a quiescent (G0) to an activated (G1) state

Efficiency of plasmapheresis: a comparison of three Italian Centres

Background. In order to support the economic and financial sustainability of the Italian health system, there is a need to define technically and economically efficient strategies that assure the self-sufficient apheretic production of plasma. Material and methods. Process and product costs at the Casa del Donatore (CD) in Bologna were determined on the basis of costing models used at Verona's Inter-hospital Department of Transfusional Medicine (IDTM) by academics from the University of Turin and those used at the Marche Regional IDTM by academics from Marche Polytechnic University. During the first phase, data was collected concerning donors, biological screening tests, the number of units produced/discarded, the materials used (individual pharmacy codes and related final expenditure), human resources (number, professional status, time involved, the number of activities per day, percentage productivity), equipment, and general costs. During the second phase, direct costs were verified and the costs common to the units produced were attributed using the functional principle. Results. The overall cost of a litre of plasma collected by means of apherisis (about \u20ac 280) was similar at the three centres, but there were differences in their cost structures that could be attributed to organisational choices, economic factors and/or structural variables. Plasmapheresis accounts for 24% of the plasma collected in Marche and the CD, but 17% of that collected in Verona, whereas the donation index is lower in the CD (1.8) than in the other two centres (2.2). The annual donor screening tests are substantially similar, but there are some differences in their timing (at the time of screening candidate donors or at the time of first donation). There are also some differences in the use of tests that are not required by law but are carried out in order to protect donors and recipients. The working times in three centres are similar, but personnel costs vary because of their different retribution policies. Discussion. Comparing the cost determinants at each centre made it possible to highlight changes that each can make in order to improve efficiency, and may lay the basis for doing the same in other organisational contexts

Differential diagnosis of neurodegenerative dementias with the explainable MRI based machine learning algorithm MUQUBIA

Biomarker-based differential diagnosis of the most common forms of dementia is becoming increasingly important. Machine learning (ML) may be able to address this challenge. The aim of this study was to develop and interpret a ML algorithm capable of differentiating Alzheimer's dementia, frontotemporal dementia, dementia with Lewy bodies and cognitively normal control subjects based on sociodemographic, clinical, and magnetic resonance imaging (MRI) variables. 506 subjects from 5 databases were included. MRI images were processed with FreeSurfer, LPA, and TRACULA to obtain brain volumes and thicknesses, white matter lesions and diffusion metrics. MRI metrics were used in conjunction with clinical and demographic data to perform differential diagnosis based on a Support Vector Machine model called MUQUBIA (Multimodal Quantification of Brain whIte matter biomArkers). Age, gender, Clinical Dementia Rating (CDR) Dementia Staging Instrument, and 19 imaging features formed the best set of discriminative features. The predictive model performed with an overall Area Under the Curve of 98%, high overall precision (88%), recall (88%), and F1 scores (88%) in the test group, and good Label Ranking Average Precision score (0.95) in a subset of neuropathologically assessed patients. The results of MUQUBIA were explained by the SHapley Additive exPlanations (SHAP) method. The MUQUBIA algorithm successfully classified various dementias with good performance using cost-effective clinical and MRI information, and with independent validation, has the potential to assist physicians in their clinical diagnosis

L'idoneit\ue0 alla donazione di sangue ed emocomponenti

L'idoneit\ue0 alla donazione di sangue ed emocomponent

Benchmark - L'architettura del progetto e i risultati del primo esercizio nazionale

L'architettura del progetto e i risultati del primo esercizio nazional

Valutazione della dimensione verticale scheletrica in ambito ortognatodontico: confronto statistico fra tre metodiche cefelometriche

Nella diagnosi ortodontica assume rilevanza la valutazione della dimensione verticale scheletrica. In questo lavoro sono state esaminate le teleradiografie in proiezione latero-laterale di 30 soggetti allo scopo di evidenziare le concordanze o discordanze nella valutazione della dimensione verticale scheletrica fra i metodi cefalometrici si Steiner, Ricketts e Jarabak. Le 3 metodiche sono state confrontate a due a due su tutti i pazienti, utilizzando come indice di concordanza statistica il Kappa di Cohen. Poichè i risultati hanno dimostrato un basso livello di concordanza fra i 3 metodi, è possibile concludere che nessuno di essi può essere indifferentemente utilizzato in sostituzione dell'altro