Autotransfusión predepósito en artroplastia total de cadera como programa de ahorro de sangre alogénica

Las necesidades transfusionales en Cirugía Ortopédica y Traumatología son elevadas, condicionando un alto coste. Existen diferentes técnicas de ahorro de sangre alogénica siendo la autotransfusión predepósito sin duda el patrón oro en la actualidad. Realizamos un estudio retrospectivo con el objeto de valorar si las técnicas de ahorro de sangre y especialmente la autotransfusión predepósito disminuyen las necesidades de transfusión alogénica en cirugía ortopédica programada de cadera. El mayor inconveniente de la autotransfusión fue el alto coste-efectividad. El principal factor que ancarece la técnica es la gran cantidad de unidades donadas y no transfundidas, que genera un rendimiento bajo de la misma. La anemización preoperatoria y la sobretransfusión pueden ser evitadas de forma sencilla con claros criterios de transfusión poco liberales. La optimización del ahorro de sangre alogénica se puede establecer mediante un programa interdisciplinar e individualizado según el tipo de cirugía y las características del paciente como la hemoglobina basal y el sexo. La autotransfusión predepósito es adecuada en cirugía ortopédica programada de cadera por su efectividad en el ahorro de sangre alogénica, su buena tolerancia y por la inocuidad del proceso.Transfusion requirements in orthopaedic surgery are raised and therefore costs are high. There are different allogenic blood saving techniques but predeposit auto- transfusion is the gold-standard at present. We performed a retrospective study with the objective of valuing the requie- rement decreasement of allogenic transfusion in hip pro- gram orthopaedic surgery through blood saving methods, specially predeposit autologous transfusion. Autologous transfusion's great problem was the raised cost-effective- ness. The main reason for the price increase of techniques used is the high number of donned units and not transfused after surgery which you end up with a low productive met- hod. Anaemia pre-surgery and overtransfusion can easily be avoided with clear inclusion lines in blood saving programs and no liberal transfusion protocols. The best way to save allogenic blood in total hip arthroplasty can be established by means of an interdisciplinar program but individualized for specific tipe of surgery and for patient's characteristics like initial haemoglobin and sex. Predeposit autologous transfusion is adequate in hip program orthopaedic surgery because its effectiveness in allogenic blood saving, its good tolerance and it is a safe method

Caracterización de la púrpura trombótica trombocitopénica congénita mediante técnicas inmunológicas y moleculares: resultados de la colección nacional del GEPTT

CO-093 Introducción: La Púrpura Trombótica Trombocitopénica congénita (PTTc) es una enfermedad ultra-rara caracterizada por un déficit severo de la enzima ADAMTS13 como consecuencia de mutaciones heredadas de forma autosómica recesiva en el gen ADAMTS13 (9q34). En este estudio, desarrollado dentro del Grupo Cooperativo Español de PTT (GEPTT), se ha llevado a cabo la creación de una colección centralizada de muestras biológicas y su caracterización inmunológica y molecular para mejorar el diagnóstico y el manejo clínico de los pacientes. Métodos: Se incluyeron en este estudio seis pacientes con diagnóstico clínico o sospecha de PTTc de diferentes hospitales españoles. Se estudió la actividad de ADAMTS13 e inhibidores mediante la técnica ELISA con el kit “TECHNOZYM® ADAMTS-13 Activity e INH” (Technoclone). Además, se realizó test Bethesda para descartar la presencia de inhibidores no IgG. Para el estudio genético, se implementó un panel de captura (SureSelect, Agilent) dirigido a la región genómica completa, incluyendo también las regiones no codificantes, del gen ADAMTS13 (chr9: 136278459 - 136325025, hg19). Las librerías de DNA se secuenciaron con la plataforma MiSeq (Illumina®) y el posible efecto patogénico de las variantes identificadas se estudió a nivel de i) proteína, utilizando predictores de cambio de aminoácido (SIFT) y de estructura de la proteína (SwissModel) y ii) splicing, con herramientas de análisis in silico (HSF) y validación funcional in vitro mediante minigenes. En 3 casos se realizó un cariotipo molecular utilizando array de SNPs (CytoScan HD, Affymetrix) para detectar regiones de pérdida de material genético y/o de heterocigosidad (LOH). Resultados: La mediana de actividad de ..

Plerixafor for PBSC mobilisation in myeloma patients with advanced renal failure: safety and efficacy data in a series of 21 patients from Europe and the USA

We describe 20 patients with myeloma and 1 with primary amyloidosis from 15 centres, all with advanced renal failure, most of whom had PBSC mobilised using plerixafor following previous failed mobilisation by conventional means (plerixafor used up-front for 4 patients). For 15 patients, the plerixafor dose was reduced to 0.16 mg/kg/day, with a subsequent dose increase in one case to 0.24 mg/kg/day. The remaining six patients received a standard plerixafor dosage at 0.24 mg/kg/day. Scheduling of plerixafor and apheresis around dialysis was generally straightforward. Following plerixafor administration, all patients underwent apheresis. A median CD34+ cell dose of 4.6 × 106 per kg was achieved after 1 (n=7), 2 (n=10), 3 (n=3) or 4 (n=1) aphereses. Only one patient failed to achieve a sufficient cell dose for transplant: she subsequently underwent delayed re-mobilisation using G-CSF with plerixafor 0.24 mg/kg/day, resulting in a CD34+ cell dose of 2.12 × 106/kg. Sixteen patients experienced no plerixafor toxicities; five had mild-to-moderate gastrointestinal symptoms that did not prevent apheresis. Fifteen patients have progressed to autologous transplant, of whom 12 remain alive without disease progression. Two patients recovered endogenous renal function post autograft, and a third underwent successful renal transplantation. Plerixafor is highly effective in mobilising PBSC in this difficult patient group

Rationale for combined therapies in severe-to-critical COVID-19 patients

An unprecedented global social and economic impact as well as a significant number of fatalities have been brought on by the coronavirus disease 2019 (COVID-19), produced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Acute SARS-CoV-2 infection can, in certain situations, cause immunological abnormalities, leading to an anomalous innate and adaptive immune response. While most patients only experience mild symptoms and recover without the need for mechanical ventilation, a substantial percentage of those who are affected develop severe respiratory illness, which can be fatal. The absence of effective therapies when disease progresses to a very severe condition coupled with the incomplete understanding of COVID-19’s pathogenesis triggers the need to develop innovative therapeutic approaches for patients at high risk of mortality. As a result, we investigate the potential contribution of promising combinatorial cell therapy to prevent death in critical patients.This research was funded by the financial support to BS from: Institute of Health Carlos III (Co-funded by Fondos FEDER), Project ICI21/00016 and Agencia Valenciana de Innovacion Projects AVI-GVA COVID-19-68 and GVA-COVI19/2021/047 and Project JDRF 2-SRA-2019-837

Rationale for combined therapies in severe-to-critical COVID-19 patients

An unprecedented global social and economic impact as well as a significant number of fatalities have been brought on by the coronavirus disease 2019 (COVID-19), produced by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Acute SARS-CoV-2 infection can, in certain situations, cause immunological abnormalities, leading to an anomalous innate and adaptive immune response. While most patients only experience mild symptoms and recover without the need for mechanical ventilation, a substantial percentage of those who are affected develop severe respiratory illness, which can be fatal. The absence of effective therapies when disease progresses to a very severe condition coupled with the incomplete understanding of COVID-19’s pathogenesis triggers the need to develop innovative therapeutic approaches for patients at high risk of mortality. As a result, we investigate the potential contribution of promising combinatorial cell therapy to prevent death in critical patients