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14. Consensus statements on vaccination in patients with haemophilia—Results from the Italian haemophilia and vaccinations (HEVA) project

Author

Santagostino E., Riva A., Cesaro S., Esposito S., Matino D., Mazzucchelli R. I., Molinari, Angelo Claudio, Mura R., Notarangelo L. D., Tagliaferri A., Di Minno G., Clerici M., Ambaglio C., Brigida Aru A., Baldacci E., Barillari G., Basso M., Bernasconi S., Bertamino M., Bertoni E., Biasoli C., Federica Biguzzi E., Bonetti E., Borchiellini A., Bulgarelli S., Cabibbo S., Cantori I., Castaman G., Castiglia P., Coluccia A., Coppetelli U., Coppola A., Cultrera D., De Candia E., Delios G., Di Gennaro L., Di Gregorio P., Di Minno M., Dragani A., Pietro Ettorre C., Franchini M., Galli M., Gallo G., Giordano P., Giuffrida G., Iannaccaro P., Lassandro G., Lazzareschi I., Linari S., Luciani M., Macchi S., Malcangi G., Malizia R., Marietta M., Marino R., Massoud M., Gabriella Mazzucconi M., Milan M., Morfini M., Napolitano M., Pasca S., Pedrazzi P., Peyvandi F. A., Piscitelli L., Pollio B., Preti P., Quintavalle G., Radossi P., Raso S., Ricca I., Rocino A., Santoro C., Carlotta Santoro R., Sarolo L., Schiavoni M., Schiavulli M., Sciancalepore P., Luisa Serino M., Mario Siragusa S., Sottilotta G., Svahn J., Valdre L., Cristina Vedovati M., Zanon E., Santagostino, E., Riva, A., Cesaro, S., Esposito, S., Matino, D., Mazzucchelli, R. I., Molinari, Angelo Claudio, Mura, R., Notarangelo, L. D., Tagliaferri, A., Di Minno, G., Clerici, M., Ambaglio, C., Brigida Aru, A., Baldacci, E., Barillari, G., Basso, M., Bernasconi, S., Bertamino, M., Bertoni, E., Biasoli, C., Federica Biguzzi, E., Bonetti, E., Borchiellini, A., Bulgarelli, S., Cabibbo, S., Cantori, I., Castaman, G., Castiglia, P., Coluccia, A., Coppetelli, U., Coppola, A., Cultrera, D., De Candia, E., Delios, G., Di Gennaro, L., Di Gregorio, P., Di Minno, M., Dragani, A., Pietro Ettorre, C., Franchini, M., Galli, M., Gallo, G., Giordano, P., Giuffrida, G., Iannaccaro, P., Lassandro, G., Lazzareschi, I., Linari, S., Luciani, M., Macchi, S., Malcangi, G., Malizia, R., Marietta, M., Marino, R., Massoud, M., Gabriella Mazzucconi, M., Milan, M., Morfini, M., Napolitano, M., Pasca, S., Pedrazzi, P., Peyvandi, F. A., Piscitelli, L., Pollio, B., Preti, P., Quintavalle, G., Radossi, P., Raso, S., Ricca, I., Rocino, A., Santoro, C., Carlotta Santoro, R., Sarolo, L., Schiavoni, M., Schiavulli, M., Sciancalepore, P., Luisa Serino, M., Mario Siragusa, S., Sottilotta, G., Svahn, J., Valdre, L., Cristina Vedovati, M., and Zanon, E.

Subjects
Adult, medicine.medical_specialty, Consensus, Delphi Technique, Vaccination schedule, Delphi method, haemophilia, 030204 cardiovascular system & hematology, Hemophilia A, Haemophilia, immunization, Hemophilia B, bleeding disorder, factor VIII inhibitor, vaccination, Child, Evidence-Based Medicine, Humans, Italy, Vaccination, 03 medical and health sciences, 0302 clinical medicine, Vaccine administration, Medicine, In patient, Clinical Haemophilia, Genetics (clinical), business.industry, Original Articles, Hematology, General Medicine, Evidence-based medicine, medicine.disease, Settore MED/38 - PEDIATRIA GENERALE E SPECIALISTICA, Immunization, Family medicine, Original Article, business, 030215 immunology
Abstract

Vaccination against communicable diseases is crucial for disease prevention, but this practice poses challenges to healthcare professionals in patients with haemophilia. Poor knowledge of the vaccination requirements for these patients and safety concerns often result in vaccination delay or avoidance. In order to address this issue, a panel of 11 Italian haemophilia and immunization experts conducted a Delphi consensus process to identify the main concerns regarding the safe use of vaccines in patients with haemophilia. The consensus was based on a literature search of the available evidence, which was used by the experts to design 27 consensus statements. A group of clinicians then rated these statements using the 5‐point Likert‐type scale (1 = strongly disagree; 5 = strongly agree). The main issues identified by the expert panel included vaccination schedule for haemophilic patients; protocol and optimal route of vaccine administration; vaccination of haemophilic patients with antibodies inhibiting coagulation factor VIII (inhibitors); and vaccination and risk of inhibitor development. This manuscript discusses these controversial areas in detail supported by the available literature evidence and provides evidence‐ and consensus‐based recommendations. Overall, participants agreed on most statements, except those addressing the potential role of vaccination in inhibitor formation. Participants agreed that patients with haemophilia should receive vaccinations according to the institutional schedule for individuals without bleeding disorders; however, vaccination of patients with haemophilia requires comprehensive planning, taking into account disease severity, type and route of vaccination, and bleeding risk. Data also suggest vaccination timing does not need to take into consideration when the patient received factor VIII replacement.

Published
2019

24. Consensus statements on vaccination in patients with haemophilia—Results from the Italian haemophilia and vaccinations (HEVA) project

Author

Santagostino, E., Riva, A., Cesaro, S., Esposito, S., Matino, D., Mazzucchelli, R. I., Molinari, A. C., Mura, R., Notarangelo, L. D., Tagliaferri, A., Di Minno, G., Clerici, M., Ambaglio, C., Brigida Aru, A., Baldacci, E., Barillari, G., Basso, M., Bernasconi, S., Bertamino, M., Bertoni, E., Biasoli, C., Federica Biguzzi, E., Bonetti, E., Borchiellini, A., Bulgarelli, S., Cabibbo, S., Cantori, I., Castaman, G., Castiglia, P., Coluccia, A., Coppetelli, U., Coppola, A., Cultrera, D., De Candia, Erica, Delios, G., Di Gennaro, L., Di Gregorio, P., Di Minno, M., Dragani, A., Pietro Ettorre, C., Franchini, M., Galli, M., Gallo, G., Giordano, P., Giuffrida, G., Iannaccaro, P., Lassandro, G., Lazzareschi, Ilaria, Linari, S., Luciani, M., Macchi, S., Malcangi, G., Malizia, R., Marietta, M., Marino, R., Massoud, M., Gabriella Mazzucconi, M., Milan, M., Morfini, M., Napolitano, M., Pasca, S., Pedrazzi, P., Peyvandi, F. A., Piscitelli, L., Pollio, B., Preti, P., Quintavalle, G., Radossi, P., Raso, S., Ricca, I., Rocino, A., Santoro, C., Carlotta Santoro, R., Sarolo, L., Schiavoni, M., Schiavulli, M., Sciancalepore, P., Luisa Serino, M., Mario Siragusa, S., Sottilotta, G., Svahn, J., Valdre, L., Cristina Vedovati, M., Zanon, E., De Candia E. (ORCID:0000-0003-0942-2819), Lazzareschi I. (ORCID:0000-0001-7221-2983), Santagostino, E., Riva, A., Cesaro, S., Esposito, S., Matino, D., Mazzucchelli, R. I., Molinari, A. C., Mura, R., Notarangelo, L. D., Tagliaferri, A., Di Minno, G., Clerici, M., Ambaglio, C., Brigida Aru, A., Baldacci, E., Barillari, G., Basso, M., Bernasconi, S., Bertamino, M., Bertoni, E., Biasoli, C., Federica Biguzzi, E., Bonetti, E., Borchiellini, A., Bulgarelli, S., Cabibbo, S., Cantori, I., Castaman, G., Castiglia, P., Coluccia, A., Coppetelli, U., Coppola, A., Cultrera, D., De Candia, Erica, Delios, G., Di Gennaro, L., Di Gregorio, P., Di Minno, M., Dragani, A., Pietro Ettorre, C., Franchini, M., Galli, M., Gallo, G., Giordano, P., Giuffrida, G., Iannaccaro, P., Lassandro, G., Lazzareschi, Ilaria, Linari, S., Luciani, M., Macchi, S., Malcangi, G., Malizia, R., Marietta, M., Marino, R., Massoud, M., Gabriella Mazzucconi, M., Milan, M., Morfini, M., Napolitano, M., Pasca, S., Pedrazzi, P., Peyvandi, F. A., Piscitelli, L., Pollio, B., Preti, P., Quintavalle, G., Radossi, P., Raso, S., Ricca, I., Rocino, A., Santoro, C., Carlotta Santoro, R., Sarolo, L., Schiavoni, M., Schiavulli, M., Sciancalepore, P., Luisa Serino, M., Mario Siragusa, S., Sottilotta, G., Svahn, J., Valdre, L., Cristina Vedovati, M., Zanon, E., De Candia E. (ORCID:0000-0003-0942-2819), and Lazzareschi I. (ORCID:0000-0001-7221-2983)

Abstract

Vaccination against communicable diseases is crucial for disease prevention, but this practice poses challenges to healthcare professionals in patients with haemophilia. Poor knowledge of the vaccination requirements for these patients and safety concerns often result in vaccination delay or avoidance. In order to address this issue, a panel of 11 Italian haemophilia and immunization experts conducted a Delphi consensus process to identify the main concerns regarding the safe use of vaccines in patients with haemophilia. The consensus was based on a literature search of the available evidence, which was used by the experts to design 27 consensus statements. A group of clinicians then rated these statements using the 5-point Likert-type scale (1 = strongly disagree; 5 = strongly agree). The main issues identified by the expert panel included vaccination schedule for haemophilic patients; protocol and optimal route of vaccine administration; vaccination of haemophilic patients with antibodies inhibiting coagulation factor VIII (inhibitors); and vaccination and risk of inhibitor development. This manuscript discusses these controversial areas in detail supported by the available literature evidence and provides evidence- and consensus-based recommendations. Overall, participants agreed on most statements, except those addressing the potential role of vaccination in inhibitor formation. Participants agreed that patients with haemophilia should receive vaccinations according to the institutional schedule for individuals without bleeding disorders; however, vaccination of patients with haemophilia requires comprehensive planning, taking into account disease severity, type and route of vaccination, and bleeding risk. Data also suggest vaccination timing does not need to take into consideration when the patient received factor VIII replacement.

Published
2019

34. The post-thrombotic syndrome in young women: retrospective evaluation of prognostic factors

Author

Biguzzi, E., Mozzi, E., Alatri, A., Taioli, E., Marco Moia, and Mannucci, P. M.

Subjects
Adult, Risk Factors, Humans, Female, Postphlebitic Syndrome, Thrombophlebitis, Prognosis, Retrospective Studies
Abstract

Post-thrombotic syndrome (PTS) in young women may cause impairment in the quality of life of otherwise healthy people. We aimed to evaluate the prevalence of PTS and its risk factors in young women. We evaluated 51 women with at least one previous episode of symptomatic, objectively documented deep vein thrombosis (DVT) before the age of 40. Each patient asked for symptoms had a physical examination, a color-coded Doppler ultrasonography of the superficial and deep venous system and an extensive laboratory evaluation for the congenital and acquired coagulation abnormalities predisposing to thrombosis. The median follow-up was 47 months. PTS was absent in 37%, mild in 55%, moderate in 4% and severe in 4% of patients. No correlation was found between PTS and the presence of coagulation abnormalities, triggering factors, recurrences, use of elastic stockings for one year after DVT, degree of recanalization, presence of superficial reflux. Patients with a body mass index (BMI)22 had an adjusted ratio of 4.7 (98 CI: 1.0-23.3) of developing the PTS. Though severe and moderate PTS are rare, mild PTS is present in the majority of young women after DVT. A BMI22 is associated to the risk of developing PTS. Attempt to control weight in women after DVT should be considered and studied to prevent PTS.

Published
1998

36. Derangement of endothelial protein C receptor and thrombomodulin expression in the intestinal mucosa of patients with inflammatory bowel diseases

Author

Saibeni, S, Faioni, E, Ferrero, S, Fontana, G, Gianelli, U, Ciulla, M, Biguzzi, E, Cordani, N, Franchi, F, Bosari, S, Cattaneo, M, Vecchi, M, Vecchi, M., CORDANI, NICOLETTA, Saibeni, S, Faioni, E, Ferrero, S, Fontana, G, Gianelli, U, Ciulla, M, Biguzzi, E, Cordani, N, Franchi, F, Bosari, S, Cattaneo, M, Vecchi, M, Vecchi, M., and CORDANI, NICOLETTA

Published
2004

37. Expression of endothelial protein C receptor and thrombomodulin in the intestinal tissue of patients with inflammatory bowel disease

Author

Faioni, E, Ferrero, S, Fontana, G, Gianelli, U, Ciulla, M, Vecchi, M, Saibeni, S, Biguzzi, E, Cordani, N, Franchi, F, Bosari, S, Cattaneo, M, Cattaneo, M., CORDANI, NICOLETTA, Faioni, E, Ferrero, S, Fontana, G, Gianelli, U, Ciulla, M, Vecchi, M, Saibeni, S, Biguzzi, E, Cordani, N, Franchi, F, Bosari, S, Cattaneo, M, Cattaneo, M., and CORDANI, NICOLETTA

Abstract

OBJECTIVE: Inflammatory bowel diseases are characterized by disorders of immunity, thrombosis of large vessels, and microthrombosis of mucosal vessels. The expression of endothelial protein C receptor (EPCR) and thrombomodulin-two receptors of the protein C pathway involved in thrombin scavenging and inflammation-was studied in intestinal resection specimens or mucosal biopsies from patients with inflammatory bowel disease and from controls. The soluble forms of the receptors in plasma were measured. DATA SOURCE: This study involved patients from two large university hospitals. After surgery or biopsy, tissue samples were either frozen or fixed in formalin and embedded in paraffin. Sections for immunohistochemistry examination were cut and tested with the specific antibodies to EPCR and thrombomodulin. RNA was extracted from frozen tissue for amplification via reverse-transcriptase polymerase chain reaction. Normal intestinal and diverticulitis tissue was used as a control. Resection samples from 36 patients with ulcerative colitis, 38 with Crohn's disease, 38 with colonic cancer, and 32 with diverticulitis were studied by immunohistochemistry, and frozen sections from the same patients were studied by immunofluorescence. Twelve biopsy specimens of adjacent intestinal areas from six patients with inflammatory bowel disease were included in the study for reverse-transcriptase polymerase chain reaction. Soluble receptors were measured in the plasma of 52 inflammatory bowel disease patients and 52 controls. DATA SUMMARY: EPCR and thrombomodulin were expressed on the mucosal endothelium of controls, and the intensity of the signal decreased in inflammatory bowel disease patients. EPCR was expressed by dendritic-like cells in controls, which also stained positive for CD21. The EPCR/CD21 dendritic-like cells were not as commonly observed in sections from ulcerative colitis patients as they were in sections from control patients (12.0 +/- 3.6 cells per high-power field vs.

Published
2004

38. Splenectomy for idiopathic thrombocytopenic purpura: Comparison of laparoscopic and conventional surgery

Author

Marassi, A, Vignali, A, Zuliani, W, Biguzzi, E, Bergamo, C, Gianotti, L, Di Carlo, V, Di Carlo, V., GIANOTTI, LUCA VITTORIO, Marassi, A, Vignali, A, Zuliani, W, Biguzzi, E, Bergamo, C, Gianotti, L, Di Carlo, V, Di Carlo, V., and GIANOTTI, LUCA VITTORIO

Abstract

This study aimed to compare the safety, efficacy, and clinical benefits of laparoscopic splenectomy (LS) to open splenectomy (OS) in patients with idiopathic thrombocytopenic purpura (ITP).

Published
1999

42. A 23bp insertion in the endothelial protein C receptor (EPCR) gene impairs EPCR function

Author

Biguzzi E, Giampiero Merati, Pc, Liaw, Bucciarelli P, Oganesyan N, Qu D, Jm, Gu, Fetiveau R, Ct, Esmon, Pm, Mannucci, and Em, Faioni

Subjects
Adult, Male, Glycosylation, Protein Conformation, DNA Mutational Analysis, Myocardial Infarction, Pilot Projects, Receptors, Cell Surface, Structure-Activity Relationship, Gene Frequency, Risk Factors, Animals, Humans, Thrombophilia, Genetic Predisposition to Disease, Age of Onset, Cells, Cultured, Venous Thrombosis, Cell Membrane, Exons, Middle Aged, Blood Coagulation Factors, Protein Structure, Tertiary, Enzyme Activation, Molecular Weight, Mutagenesis, Insertional, Protein Transport, Italy, Female, Endothelium, Vascular, Protein Processing, Post-Translational, Protein Binding, Protein C
Abstract

EPCR is a type I transmembrane protein, highly expressed on the endothelium of large vessels, that binds protein C and augments its activation. In this study, a 23bp insertion in the EPCR gene was found in 4/198 survivors of myocardial infarction and 3/194 patients with deep vein thrombosis. The EPCR gene with the insertion predicts a protein that lacks part of the extracellular domain, the transmembrane domain and the cytoplasmic tail. Expression studies showed that the truncated protein is not localized on the cell surface, cannot be secreted in the culture medium, and does not bind activated protein C. Since protein C activation depends on the concentration of EPCR, patients with the EPCR insertion could have a diminished protein C activation capacity. Further clinical studies of adequate samples size are necessary to establish whether or not the EPCR insertion predisposes to the development of thrombotic events.

44. Intrauterine growth restriction and genetic predisposition to thrombophilia

Author

Franchi, F., IRENE CETIN, Todros, T., Antonazzo, P., Nobile Santis, M. S., Cardaropoli, S., Bucciarelli, P., and Biguzzi, E.

Subjects
Adult, Male, Fetal Growth Retardation, Polymorphism, Genetic, Adolescent, Pregnancy Complications, Hematologic, Infant, Newborn, Doppler ultrasound, Pregnancy, Case-Control Studies, Humans, Thrombophilia, Female, Genetic Predisposition to Disease, Intrauterine Growth Retardation
Abstract

Intrauterine growth restriction is an important cause of morbidity and mortality. Its pathogenesis is still a matter of debate. The aim of this study was to evaluate the association between intrauterine growth restriction (diagnosed in utero by serial ultrasound examinations and characterized by abnormal umbilical arterial Doppler velocimetry) and thrombophilic polymorphisms (factor V Leiden, prothrombin G20210A) or methylenetetrahydrofolate reductase C677T carried by mothers and/or neonates.This was a case-control study with prospective enrollment. Fetuses with intrauterine growth restriction were included if they had three characteristics: 1) reduced intrauterine growth (measured in utero by ultrasound); 2) birth weight below the 10th percentile; 3) abnormal Doppler velocimetry of the umbilical artery. The three polymorphisms were evaluated in 48 cases and in 98 controls by polymerase chain reaction (PCR) and restriction analysis.Factor V Leiden was present in 2/48 (4%) mothers or neonates among cases and 7/98 (7%) among controls. Prothrombin G20210A was present in 0/48 (0%) mothers or neonates among cases and 4/98 (4%) among controls. Methylenetetrahydrofolate reductase C677T was present in 16/48 (33%) mothers or neonates among cases and 22/98 (22%) controls. Overall the prevalence of the polymorphisms in mothers and/or neonates was 18/48 (37%) in cases and 33/98 (34%) in controls.No association was found in this study between intrauterine growth restriction with abnormal umbilical blood flow and thrombophilic polymorphisms or methylenetetrahydrofolate reductase C677T.

45. High Prevalence of Helicobacter pyloriInfection in Patients With Colonic Adenomas and Carcinomas

Author

Meucci, G., Tatarella, M., Vecchi, M., Ranzi, M. L., Biguzzi, E., Beccari, G., Clerici, E., and de Franchis, R.

Abstract

In some uncontrolled studies, a high prevalence of Helicobacter pyloriinfection unexpectedly has been found in patients with colorectal cancer. The purpose of the study was to investigate the prevalence of H. pyloriinfection in patients with colonic polyps or cancer. We reviewed 50 consecutive patients with either colonic adenomas or cancer who entered a preliminary case-control study. For each patient, 2 age- and gender-matched control subjects were selected (72 males; mean age, 63.1 years). A further 44 consecutive patients (30 with polyps and 14 with cancer) subsequently were enrolled. The H. pyloriprevalence in patients with either polyps or cancer was compared with that in control subjects. Anti-H. pyloriimmunoglobulin G antibodies were assayed by an immunoenzymatic method. The prevalence of H. pyloriantibodies was 49 (49%) of 100 in control subjects, 40 (71.4%) of 56 in patients with polyps (p < 0.006 vs. control subjects), and 21 (55%) of 38 in patients with cancer (not significant). Among patients with colorectal cancer, H. pyloriprevalence was 9 (69.2%) of 13 for patients evaluated at the time of diagnosis and 12 (48%) of 25 for patients evaluated 1 to 9 years after surgery.

Published
1997

46. Expression of endothelial protein C receptor and thrombomodulin in the intestinal tissue of patients with inflammatory bowel disease

Author

Michele M. Ciulla, Franca Franchi, Simone Saibeni, Marco Cattaneo, Elena M. Faioni, Silvano Bosari, Stefano Ferrero, Gessica Fontana, Eugenia Biguzzi, Umberto Gianelli, Maurizio Vecchi, Nicoletta Cordani, Faioni, E, Ferrero, S, Fontana, G, Gianelli, U, Ciulla, M, Vecchi, M, Saibeni, S, Biguzzi, E, Cordani, N, Franchi, F, Bosari, S, and Cattaneo, M

Subjects
Adult, Male, Pathology, medicine.medical_specialty, Thrombomodulin, Receptors, Cell Surface, Inflammation, Critical Care and Intensive Care Medicine, Inflammatory bowel disease, EPCR, Thrombin, Antigens, CD, Intensive care, Biopsy, medicine, Humans, Aged, Glycoproteins, Endothelial protein C receptor, medicine.diagnostic_test, business.industry, Endothelins, Endothelial Protein C Receptor, Middle Aged, Inflammatory Bowel Diseases, medicine.disease, Ulcerative colitis, Female, Endothelium, Vascular, medicine.symptom, business, medicine.drug
Abstract

Objective: Inflammatory bowel diseases are characterized by disorders of immunity, thrombosis of large vessels, and microthrombosis of mucosal vessels. The expression of endothelial protein C receptor (EPCR) and thrombomodulin-two receptors of the protein C pathway involved in thrombin scavenging and inflammation-was studied in intestinal resection specimens or mucosal biopsies from patients with inflammatory bowel disease and from controls. The soluble forms of the receptors in plasma were measured. Data Source: This study involved patients from two large university hospitals. After surgery or biopsy, tissue samples were either frozen or fixed in formalin and embedded in paraffin. Sections for immunohistochemistry examination were cut and tested with the specific antibodies to EPCR and thrombomodulin. RNA was extracted from frozen tissue for amplification via reverse-transcriptase polymerase chain reaction. Normal intestinal and diverticulitis tissue was used as a control. Resection samples from 36 patients with ulcerative colitis, 38 with Crohn's disease, 38 with colonic cancer, and 32 with diverticulitis were studied by immunohistochemistry, and frozen sections from the same patients were studied by immunofluorescence. Twelve biopsy specimens of adjacent intestinal areas from six patients with inflammatory bowel disease were included in the study for reverse-transcriptase polymerase chain reaction. Soluble receptors were measured in the plasma of 52 inflammatory bowel disease patients and 52 controls. Data Summary: EPCR and thrombomodulin were expressed on the mucosal endothelium of controls, and the intensity of the signal decreased in inflammatory bowel disease patients. EPCR was expressed by dendritic-like cells in controls, which also stained positive for CD21. The EPCR + /CD21 + dendritic-like cells were not as commonly observed in sections from ulcerative colitis patients as they were in sections from control patients (12.0 ± 3.6 cells per high-power field vs. 23.8 ± 10.4 cells per high-power field, p = .03), and this decrease was less evident in sections from Crohn's disease patients. Levels of messenger RNA for EPCR paralleled protein expression. Soluble thrombomodulin and EPCR levels were both higher in patients than in controls: 41.5 vs. 26.0 ng/mL (p

Published
2004

47. Splenectomy for idiopathic thrombocytopenic purpura

Author

W. Zuliani, A. Vignali, Luca Gianotti, E. Biguzzi, C. Bergamo, V. Di Carlo, A. Marassi, Marassi, A, Vignali, A, Zuliani, W, Biguzzi, E, Bergamo, C, Gianotti, L, Di Carlo, V, Vignali, Andrea, and Di Carlo, V.

Subjects
Adult, Male, Laparoscopic surgery, medicine.medical_specialty, medicine.medical_treatment, Splenectomy, Normal Distribution, Thrombotic thrombocytopenic purpura, Statistics, Nonparametric, Follow-Up Studie, immune system diseases, hemic and lymphatic diseases, Laparotomy, medicine, Humans, Laparoscopy, Aged, Purpura, Thrombocytopenic, Idiopathic, medicine.diagnostic_test, business.industry, Middle Aged, medicine.disease, Thrombocytopenic purpura, Surgery, Treatment Outcome, Hematologic disease, Female, business, Spleen, Human, Follow-Up Studies, Abdominal surgery
Abstract

This study aimed to compare the safety, efficacy, and clinical benefits of laparoscopic splenectomy (LS) to open splenectomy (OS) in patients with idiopathic thrombocytopenic purpura (ITP).The results from 14 consecutive patients who underwent LS for ITP were reviewed and compared with the results from patients who underwent OS for the same disease. Demographics, concomitant disease on admission, and platelet counts were evaluated, as were details of the surgical procedure, postoperative physiologic status, and hospital stay.Mean operative time was 88.3 min for OS and 146.4 min in LS group (p0.05). The conversion rate to open splenectomy was 7.1. Therapeutic response to splenectomy was 92.8% in the LS group and 86.6% in the OS group. Bowel canalization, return to liquid diet, and length of hospital stay were all significantly delayed in the OS group as compared with those who underwent LS (p = 0.01, p = 0.02, p = 0.005, respectively). In the OS group the morbidity rate was 13.3%, whereas in the LS group it was 7.1%.Laparoscopic splenectomy represents a valid alternative to conventional splenectomy in the treatment of ITP.

Published
1999

48. The Influence of Altitude, Urbanization, and Local Vaccination Centers on Vaccine Uptake within an Italian Health District: An Analysis of 15,000 Individuals Eligible for Vaccination.

Author

Ceccarelli A, Soro G, Reali C, Biguzzi E, Farneti R, Frassineti V, Angelini R, Belloli GL, Gori D, and Montalti M

Abstract

In Italy, free vaccinations for Herpes Zoster (HZ), pneumococcal (PCV), and influenza (FLU) are recommended each year for individuals turning 65. Despite this, achieving optimal vaccination coverage remains challenging. This study assesses coverage rates for HZ, PCV, and FLU in Forlì, Northern Italy, and examines how altitude, urban planning, and health organization variables (such as the presence of a vaccination center) impact vaccine uptake. Vaccination coverages were calculated for birth cohorts between 1952 and 1958 for each municipality in the Forlì area as of 1 March 2024. The geographical factors influencing the vaccination uptake were extracted from the Italian National Institute of Statistics (ISTAT) records and evaluated through a multivariate analysis. The sample analyzed included 15,272 vaccine campaign targets from Forlì's province (185,525 citizens); the vaccine uptake rates for HZ, PCV, and FLU were 26.9%, 36.7%, and 43.5%, respectively. Gender did not appear to influence vaccine uptake. Living in a flat area appeared to increase vaccine uptake in a statistically significant way for all the vaccinations when compared to a mountainous area (HZ: OR: 1.50, PCV: OR: 1.33, FLU: OR: 1.67). The presence of a vaccine service in low-urbanized areas was shown to increase vaccine uptake for all vaccinations (HZ: OR: 1.65, PCV: OR: 1.93, FLU: OR: 1.53) compared with low-urbanized areas without a vaccination center or more urbanized areas with a vaccination center. This study emphasizes the significance of the territorial context, along with the ease of access to vaccinations and geographic barriers, as key determinants in achieving vaccination targets. Local health authorities should consider these factors when implementing vaccination campaigns.

Published
2024
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49. Anti-PF4 immunothrombosis without proximate heparin or adenovirus vector vaccine exposure.

Author

Schönborn L, Esteban O, Wesche J, Dobosz P, Broto M, Puig SR, Fuhrmann J, Torres R, Serra J, Llevadot R, Palicio M, Wang JJ, Gordon TP, Lindhoff-Last E, Hoffmann T, Alberio L, Langer F, Boehme C, Biguzzi E, Grosse L, Endres M, Liman T, Thiele T, Warkentin TE, and Greinacher A

Subjects
Heparin, Vaccination, Humans, Platelet Factor 4 metabolism, Male, Female, Child, Preschool, Child, Adult, Thrombocytopenia diagnosis, Thrombocytopenia pathology, Antibodies analysis, Thrombosis diagnosis, Thrombosis pathology
Abstract

Abstract: Platelet-activating anti-platelet factor 4 (PF4)/heparin antibodies and anti-PF4 antibodies cause heparin-induced thrombocytopenia (HIT) and vaccine-induced immune thrombocytopenia and thrombosis (VITT), respectively. Diagnostic and treatment considerations differ somewhat between HIT and VITT. We identified patients with thrombocytopenia and thrombosis without proximate heparin exposure or adenovirus-based vaccination who tested strongly positive by PF4/polyanion enzyme-immunoassays and negative/weakly positive by heparin-induced platelet activation (HIPA) test but strongly positive by PF4-induced platelet activation (PIPA) test (ie, VITT-like profile). We tested these patients by a standard chemiluminescence assay that detects anti-PF4/heparin antibodies found in HIT (HemosIL AcuStar HIT-IgG(PF4-H)) as well as a novel chemiluminescence assay for anti-PF4 antibodies found in VITT. Representative control sera included an exploratory anti-PF4 antibody-positive but HIPA-negative/weak cohort obtained before 2020 (n = 188). We identified 9 patients with a clinical-pathological profile of a VITT-like disorder in the absence of proximate heparin or vaccination, with a high frequency of stroke (arterial, n = 3; cerebral venous sinus thrombosis, n = 4), thrombocytopenia (median platelet count nadir, 49 × 109/L), and hypercoagulability (greatly elevated D-dimer levels). VITT-like serological features included strong reactivity by PIPA (aggregation <10 minutes in 9/9 sera) and positive testing in the novel anti-PF4 chemiluminescence assay (3/9 also tested positive in the anti-PF4/heparin chemiluminescence assay). Our exploratory cohort identified 13 additional patient sera obtained before 2020 with VITT-like anti-PF4 antibodies. Platelet-activating VITT-like anti-PF4 antibodies should be considered in patients with thrombocytopenia, thrombosis, and very high D-dimer levels, even without a proximate exposure to heparin or adenovirus vector vaccines., (© 2023 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved.)

Published
2023
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