Comparison of the Hemostatic Efficacy of Pathogen-Reduced Platelets vs Untreated Platelets in Patients With Thrombocytopenia and Malignant Hematologic Diseases: A Randomized Clinical Trial

Importance: Pathogen reduction of platelet concentrates may reduce transfusion-transmitted infections but is associated with qualitative impairment, which could have clinical significance with regard to platelet hemostatic capacity. Objective: To compare the effectiveness of platelets in additive solution treated with amotosalen-UV-A vs untreated platelets in plasma or in additive solution in patients with thrombocytopenia and hematologic malignancies. Design, Setting, and Participants: The Evaluation of the Efficacy of Platelets Treated With Pathogen Reduction Process (EFFIPAP) study was a randomized, noninferiority, 3-arm clinical trial performed from May 16, 2013, through January 21, 2016, at 13 French tertiary university hospitals. Clinical signs of bleeding were assessed daily until the end of aplasia, transfer to another department, need for a specific platelet product, or 30 days after enrollment. Consecutive adult patients with bone marrow aplasia, expected hospital stay of more than 10 days, and expected need of platelet transfusions were included. Interventions: At least 1 transfusion of platelets in additive solution with amotosalen-UV-A treatment, in plasma, or in additive solution. Main Outcomes and Measures: The proportion of patients with grade 2 or higher bleeding as defined by World Health Organization criteria. Results: Among 790 evaluable patients (mean [SD] age, 55 [13.4] years; 458 men [58.0%]), the primary end point was observed in 126 receiving pathogen-reduced platelets in additive solution (47.9%; 95% CI, 41.9%-54.0%), 114 receiving platelets in plasma (43.5%; 95% CI, 37.5%-49.5%), and 120 receiving platelets in additive solution (45.3%; 95% CI, 39.3%-51.3%). With a per-protocol population with a prespecified margin of 12.5%, noninferiority was not achieved when pathogen-reduced platelets in additive solution were compared with platelets in plasma (4.4%; 95% CI, -4.1% to 12.9%) but was achieved when the pathogen-reduced platelets were compared with platelets in additive solution (2.6%; 95% CI, -5.9% to 11.1%). The proportion of patients with grade 3 or 4 bleeding was not different among treatment arms. Conclusions and Relevance: Although the hemostatic efficacy of pathogen-reduced platelets in thrombopenic patients with hematologic malignancies was noninferior to platelets in additive solution, such noninferiority was not achieved when comparing pathogen-reduced platelets with platelets in plasma. Trial Registration: clinicaltrials.gov Identifier: NCT01789762

ABO Blood Group Incompatibility Protects Against SARS-CoV-2 Transmission

International audienceABO blood groups appear to be associated with the risk of SARS-CoV-2 infection, but the underlying mechanisms and their real importance remain unclear. Two hypotheses have been proposed: ABO compatibility-dependence (neutralization by anti-ABO antibodies) and ABO-dependent intrinsic susceptibility (spike protein attachment to histo-blood group glycans). We tested the first hypothesis through an anonymous questionnaire addressed to hospital staff members. We estimated symptomatic secondary attack rates (SAR) for 333 index cases according to spouse ABO blood group compatibility. Incompatibility was associated with a lower SAR (28% vs. 47%; OR 0.43, 95% CI 0.27–0.69), but no ABO dependence was detected in compatible situations. For the second hypothesis, we detected no binding of recombinant SARS-CoV-2 RBD to blood group-containing glycans. Thus, although no intrinsic differences in susceptibility according to ABO blood type were detected, ABO incompatibility strongly decreased the risk of COVID-19 transmission, suggesting that anti-ABO antibodies contribute to virus neutralization

Hommes et gens du roi

Sous l’Ancien Régime, les parlements, de Paris comme de province, étaient au cœur du fonctionnement de l’État. Têtes du système judiciaire français, mais aussi dépositaires des lois autant qu’administrateurs des questions les plus diverses, ils assumaient bien des aspects de la bonne marche du royaume. Cependant, ces cours avaient la réputation non usurpée de se montrer régulièrement indociles, voire rebelles aux yeux de certains ; la Fronde au xviie siècle et les querelles chroniques du xviiie siècle en sont les signes les plus manifestes. Pourtant, au sein de ces cours, le pouvoir royal a toujours eu des partisans, qu’il s’agisse de personnes étant, de par leur fonction, les « représentants » de la monarchie au sein de la cour (les gens du roi) ou de magistrats qui, pour des raisons personnelles et de façon informelle, défendaient la position du souverain (les hommes du roi). Or, si les procureurs généraux sont de moins en moins pour nous des inconnus, on sait en revanche peu de choses des premiers présidents au parlement, tandis que les partisans du pouvoir royal sont souvent ignorés au profit de ceux qui ont incarnés l’opposition à la monarchie. Les seize contributions réunies dans cet ouvrage se proposent de compléter notre connaissance historique de ce groupe politique et social, en s’intéressant â la manière dont ces magistrats ont pu servir le roi, à leurs carrières, à la façon de mener leur travail, et en se focalisant tout particulièrement sur les premiers présidents

Prophylactic platelet transfusion response in critically ill patients: a prospective multicentre observational study

Abstract Background Response to prophylactic platelet transfusion is suspected to be inconsistent in critically ill patients questioning how to optimize transfusion practices. This study aimed to describe prophylactic platelet transfusion response, to identify factors associated with a suboptimal response, to analyse the correlation between corrected count increment and platelet count increment and to determine the association between poor platelet transfusion response and clinical outcomes. Methods This prospective multicentre observational study recruited patients who received at least one prophylactic platelet transfusion in one of the nine participating intensive care units for a period up to 16 months. Poor platelet transfusion response was defined as a corrected count increment (CCI) that adjusts for platelet dose and body surface area, less than 7 at 18–24 h after platelet transfusion. Factors associated with poor platelet transfusion response were assessed in a mixed-effect model. Sensitivity analyses were conducted in patients with and without haematology malignancy and chemotherapy. Results Poor platelet transfusion response occurred in 349 of the 472 (73.9%) prophylactic platelet transfusions and in 141/181 (77.9%) patients. The mixed-effect model identified haemoglobin at ICU admission (odds ratio (OR): 0.79 [95% confidence interval (CI) 0.7–0.89]) and body mass index (BMI) (OR: 0.93 [0.89–0.98]) being positively and independently associated with platelet transfusion response, while a haematological malignancy (OR 1.93 [1.09–3.43]), sepsis as primary ICU admission diagnosis (OR: 2.81 [1.57–5.03]), SOFA score (OR 1.10 [1.03; 1.17]) and maximum storage duration of platelet (OR: 1.24 [1.02–1.52]) were independently associated with a suboptimal platelet increment. Clinical outcomes did not differ between groups, nor the requirement for red blood cells. Poor platelet transfusion response was found in 93.5% of patients with haematology malignancy and chemotherapy. Conclusions In this study of critically ill patients, of whom more than half had bone marrow failure, almost three quarters of prophylactic platelet transfusions led to suboptimal platelet increment measured 18 to 24 h following platelet transfusion. Platelet storage duration was the only factor associated with poor platelet response that may be accessible to intervention. Trial registration in October 2017: ClinicalTrials.gov: NCT03325140

Les Parlements et la vie de la cité (xvie-xviiie siècle)

Les parlements d'Ancien Régime ont joué un rôle très important dans la vie sociale au travers des fonctions de contrôle, de direction ou d'impulsion qu'ils ont été appelés à remplir au sein des sociétés urbaines dans des domaines aussi divers que la librairie, l'assistance publique ou la lutte contre les grandes épidémies ; au travers aussi des relations entre les milieux parlementaires et les élites des grandes cités qui abritaient ces institutions. Tout en privilégiant le parlement de Normandie et la ville de Rouen, les auteurs ont également abordé ces différents thèmes pour d'autres parlements, parmi les plus importants, et d'autres métropoles provinciales : Dijon, Besançon, Bordeaux, Grenoble et Rennes