Effects of spaceflight on erythropoiesis: a study on neocytolysis

Neocytolysis, i.e. destruction of young red blood cells (RBC), occurs in astronauts over the spaceflight first days. Due to microgravity, a central blood pooling occurs. The consequent increased diuresis and decreased plasma volume cause haematocrit increase. Therefore, EPO synthesis is down regulated, a fact that associated to neocytolysis, leads to a fast reduction of RBC mass. We have analysed a panel of plasma and RBC parameters which can be related to young red cells destruction on blood samples drawn from four astronauts before and after a 10-11 spaceflight days. After the spaceflight, ferritin plasma levels were increased in three subjects, indicating a possible haemolytic process recently occurred. The percentage of young RBCs was decreased and a small number of those left over exposed phosphatydilserine (PS) on the outer membrane layer, thereby showing an \u201capoptotic-like\u201d phenotype, able to trigger ingestion by macrophages. A decreased expression of both \u201cprotective\u201d membrane molecules CD55 and CD47 on young RBCs was also observed

Thrombophilic mutations as risk factor for retinal vein occlusion: A case-control study

Background: Retinal vein occlusion (RVO) is the second most common retinal vein disease and an important cause of blindness and visual morbidity. Many conditions are associated with RVO but the real role of the thrombophilic mutations is still unclear. Aim: To evaluate the potential role of thrombophilic mutations in RVO. Methods: We have evaluated 113 patients with RVO and compared with 104 volunteer controls. The controls were all healthy blood donors without previous venous thromboembolism episode or arterial thromboembolism episode. All patients were tested for 5 gene variants (here all named as mutations): factor V (FV) Leiden (G1691A), factor II (FII; G20210A), 5,1-methylenetetra-hydrofolate reductase (MTHFR; C677T), plasminogen activator inhibitor 1 (PAI-1; 4G/5G), and angiotensin-converting enzyme (ACE; Del/Ins). Statistical analysis were performed by the 2-tailed chi-square test. Results: Statistical test showed that TT homozygous patients of the MTHFR C677T mutation (P = .017) and heterozygous GA patients of the FII G20210A mutation (P = .018) were significantly higher than that in controls. For FV Leiden, even if the values were higher in patients than in controls, P value was not statistically significant. Conversely, for the ACE (Ins/Del) and PAI-1 (4G/5G) mutations, no difference was observed among genotypes of patients with RVO and control participants. Conclusions: In our study, the FII G20210A and the MTHFR C677T mutations resulted significantly higher in patients than in controls; in contrast, thrombophilic mutation of FV, ACE, and PAI-1 genes was not statistically correlated with RVO. In spite of having found an association between some thrombophilic mutations and RVO, more studies with a major number of patients are necessary to determine the final role of these gene variant

Pain assessment and management in haemophilia: A survey among Italian patients and specialist physicians

Introduction: Persons with haemophilia (PWH) experience recurrent joint bleeding which leads from early synovitis to irreversible joint damage. Pain strongly affects patients’ quality of life, as PWH suffer from acute pain associated with haemarthroses and chronic pain due to arthritic and degenerative complications. Aim: To investigate pain issues among PWH and their treaters in Italy. Methods: Persons with haemophilia and specialist physicians responded to a survey focused on pain characteristics, assessment, and management by phone call and online, respectively. Results: One hundred and nineteen patients (76% severe haemophilia, 61% ≥18 years) and 44 physicians were involved. Pain was reported by 61% of PWH; among those who did not experience pain, 70% were children on prophylaxis. Patients described pain as chronic (71%), acute (69%) or postoperative (8%), and rated it as severe in 65% of cases. Clinicians reported lower percentages of patients with pain (46%), classified as chronic (58%), acute (33%) or postoperative (21%), half using specific scales. Pain was systematically investigated by treaters according to 36% of patients. Paracetamol was largely the most prescribed first-line pain therapy (89%), as well the most employed analgesic by PWH (51%), who also used non-steroidal anti-inflammatory drugs (24%), cyclo-oxygenase-2 inhibitors (21%) or opioids (26%). To manage pain, 61% of clinicians stated to collaborate with other specialists. Physiotherapy was often suggested but less frequently used by PWH. Conclusions: Pain is under-recognized and unsatisfactorily addressed by haemophilia treatment centre (HTC) clinicians, with discrepant management compared to PWH responses. Education in systematic pain assessment and multidisciplinary treatment and development of management guidelines are highly needed