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2. Transfusion-induced red blood cell alloimmunisation is unhampered in elderly patients

Author

Oud, J.A., Evers, D., Haas, M. de, Vooght, K.M. De, Kerkhof, D. van de, Som, N., Péquériaux, N.C.V., Hudig, F., Bom, J.G. van der, Zwaginga, J.J., Oud, J.A., Evers, D., Haas, M. de, Vooght, K.M. De, Kerkhof, D. van de, Som, N., Péquériaux, N.C.V., Hudig, F., Bom, J.G. van der, and Zwaginga, J.J.

Abstract

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Published
2022

4. The effect of extended c, E and K matching in females under 45 years of age on the incidence of transfusion-induced red blood cell alloimmunisation

Author

Oud, J.A., Evers, D., Haas, M. de, Vooght, K.M. De, Kerkhof, D. van de, Som, N., Péquériaux, N.C.V., Hudig, F., Albersen, A., Bom, J.G. van der, Zwaginga, J.J., Oud, J.A., Evers, D., Haas, M. de, Vooght, K.M. De, Kerkhof, D. van de, Som, N., Péquériaux, N.C.V., Hudig, F., Albersen, A., Bom, J.G. van der, and Zwaginga, J.J.

Abstract

Contains fulltext : 244107.pdf (Publisher’s version ) (Open Access), Maternal alloantibodies directed against fetal red blood cell (RBC) antigens may cause potentially life-threatening haemolytic disease of the fetus and newborn (HDFN). Dutch transfusion guidelines therefore prescribe preventive cEK matching for all (pre-)fertile females. To quantify the impact of cEK matching, we compared overall and antigen-specific cumulative RBC alloimmunisation incidences in females and males aged <45 years. Among a multicentre cohort comprised of patients who received their first and subsequent RBC unit between 2005 and 2019, first-formed RBC alloantibodies were detected in 47 of 2998 (1·6%) females and 49 of 2507 (2·0%) males. Comparing females and males, overall alloimmunisation incidences were comparable (3·1% [95% confidence interval (CI) 2·1-4·4] versus 3·5% (95% CI 2·4-4·9, P = 0·853) after 10 units transfused). However, cEK alloimmunisation incidences were significantly lower among females (0·6% (95% CI 0·3-1.5) versus 2·2% (95% CI 1·5-3·4, P = 0·001) after 10 units transfused). Yet, despite cEK-matching guidelines being in effect, 6·5%, 3·6% and 0·2% of all RBC units remained mismatched for c, E or K antigens respectively. Most of these mismatches were almost always due to emergency settings. Even though cEK alloimmunisation was not prevented completely, implementation of cEK matching resulted in an alloantigen-exposure risk reduction of up to 98%.

Published
2021

5. Association between renal failure and red blood cell alloimmunization among newly transfused patients

Author

Oud, J.A., Evers, D., Middelburg, R.A., Vooght, K.M. De, Kerkhof, D. van de, Visser, O, Péquériaux, N.C.V., Hudig, F., Bom, J.G. van der, Zwaginga, J.J., Oud, J.A., Evers, D., Middelburg, R.A., Vooght, K.M. De, Kerkhof, D. van de, Visser, O, Péquériaux, N.C.V., Hudig, F., Bom, J.G. van der, and Zwaginga, J.J.

Abstract

Item does not contain fulltext, BACKGROUND: Renal failure and renal replacement therapy (RRT) affect the immune system and could therefore modulate red blood cell (RBC) alloimmunization after transfusion. STUDY DESIGN AND METHODS: We performed a nationwide multicenter case-control study within a source population of newly transfused patients between 2005 and 2015. Using conditional multivariate logistic regression, we compared first-time transfusion-induced RBC alloantibody formers (N = 505) with two nonalloimmunized recipients with similar transfusion burden (N = 1010). RESULTS: Renal failure was observed in 17% of the control and 13% of the case patients. A total of 41% of the control patients and 34% of case patients underwent acute RRT. Renal failure without RRT was associated with lower alloimmunization risks after blood transfusion (moderate renal failure: adjusted relative rate [RR], 0.82 [95% confidence interval (CI), 0.67-1.01]); severe renal failure, adjusted RR, 0.76 [95% CI, 0.55-1.05]). With severe renal failure patients mainly receiving RRT, the lowest alloimmunization risk was found in particularly these patients [adjusted RR 0.48 (95% CI 0.39-0.58)]. This was similar for patients receiving RRT for acute or chronic renal failure (adjusted RR, 0.59 [95% CI, 0.46-0.75]); and adjusted RR, 0.62 [95% CI 0.45-0.88], respectively). CONCLUSION: These findings are indicative of a weakened humoral response in acute as well as chronic renal failure, which appeared to be most pronounced when treated with RRT. Future research should focus on how renal failure and RRT mechanistically modulate RBC alloimmunization.

Published
2021

6. Harmonizing light transmission aggregometry in the Netherlands by implementation of the SSC-ISTH guideline

Author

Munnix, I.C.A., Van Oerle, R., Verhezen, P., Kuijper, P., Hackeng, C.M., Hopman-Kerkhoff, H.I.J., Hudig, F., van de Kerkhof, D., Leyte, A., de Maat, M.P.M., Oude Elferink, R.F.M., Ruinemans-Koerts, J., Schoorl, M., Slomp, J., Soons, H., Stroobants, A., van Wijk, E., Henskens, Y.M.C., Munnix, I.C.A., Van Oerle, R., Verhezen, P., Kuijper, P., Hackeng, C.M., Hopman-Kerkhoff, H.I.J., Hudig, F., van de Kerkhof, D., Leyte, A., de Maat, M.P.M., Oude Elferink, R.F.M., Ruinemans-Koerts, J., Schoorl, M., Slomp, J., Soons, H., Stroobants, A., van Wijk, E., and Henskens, Y.M.C.

Abstract

Light transmission aggregometry (LTA) is considered the gold standard method for evaluation of platelet function. However, there are a lot of variation in protocols (pre-analytical procedures and agonist concentrations) and results. The aim of our study was to establish a national LTA protocol, to investigate the effect of standardization and to define national reference values for LTA. The SSC guideline was used as base for a national procedure. Almost all recommendations of the SSC were followed e.g. no adjustment of PRP, citrate concentration of 109 mM, 21 needle gauge, fasting, resting time for whole blood and PRP, centrifugation time, speed and agonists concentrations. LTA of healthy volunteers was measured in a total of 16 hospitals with 5 hospitals before and after standardization. Results of more than 120 healthy volunteers (maximum aggregation %) were collected, with participating laboratories using 4 different analyzers with different reagents. Use of low agonist concentrations showed high variation before and after standardization, with the exception of collagen. For most high agonist concentrations (ADP, collagen, ristocetin, epinephrine and arachidonic acid) variability in healthy subjects decreased after standardization. We can conclude that a standardized Dutch protocol for LTA, based on the SSC guideline, does not result in smaller variability in healthy volunteers for all agonist concentrations.

Published
2021

7. Harmonizing light transmission aggregometry in the Netherlands by implementation of the SSC-ISTH guideline

Author

Munnix, I. C.A., Van Oerle, R., Verhezen, P., Kuijper, P., Hackeng, C. M., Hopman-Kerkhoff, H. I.J., Hudig, F., Van De Kerkhof, D., Leyte, A., De Maat, M. P.M., Oude Elferink, R. F.M., Ruinemans-Koerts, J., Schoorl, M., Slomp, J., Soons, H., Stroobants, A., Van Wijk, E., Henskens, Y. M.C., Munnix, I. C.A., Van Oerle, R., Verhezen, P., Kuijper, P., Hackeng, C. M., Hopman-Kerkhoff, H. I.J., Hudig, F., Van De Kerkhof, D., Leyte, A., De Maat, M. P.M., Oude Elferink, R. F.M., Ruinemans-Koerts, J., Schoorl, M., Slomp, J., Soons, H., Stroobants, A., Van Wijk, E., and Henskens, Y. M.C.

Abstract

Light transmission aggregometry (LTA) is considered the gold standard method for evaluation of platelet function. However, there are a lot of variation in protocols (pre-analytical procedures and agonist concentrations) and results. The aim of our study was to establish a national LTA protocol, to investigate the effect of standardization and to define national reference values for LTA. The SSC guideline was used as base for a national procedure. Almost all recommendations of the SSC were followed e.g. no adjustment of PRP, citrate concentration of 109 mM, 21 needle gauge, fasting, resting time for whole blood and PRP, centrifugation time, speed and agonists concentrations. LTA of healthy volunteers was measured in a total of 16 hospitals with 5 hospitals before and after standardization. Results of more than 120 healthy volunteers (maximum aggregation %) were collected, with participating laboratories using 4 different analyzers with different reagents. Use of low agonist concentrations showed high variation before and after standardization, with the exception of collagen. For most high agonist concentrations (ADP, collagen, ristocetin, epinephrine and arachidonic acid) variability in healthy subjects decreased after standardization. We can conclude that a standardized Dutch protocol for LTA, based on the SSC guideline, does not result in smaller variability in healthy volunteers for all agonist concentrations.

Published
2021

9. Harmonizing light transmission aggregometry in the Netherlands by implementation of the SSC-ISTH guideline

Author

Munnix, I.C.A., primary, Van Oerle, R., additional, Verhezen, P., additional, Kuijper, P., additional, Hackeng, C.M., additional, Hopman-Kerkhoff, H.I.J., additional, Hudig, F., additional, Van De Kerkhof, D., additional, Leyte, A., additional, De Maat, M.P.M., additional, Oude Elferink, R.F.M., additional, Ruinemans-Koerts, J., additional, Schoorl, M., additional, Slomp, J., additional, Soons, H., additional, Stroobants, A., additional, Van Wijk, E., additional, and Henskens, Y.M.C., additional

Published
2020
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11. Association of Timing of Plasma Transfusion With Adverse Maternal Outcomes in Women With Persistent Postpartum Hemorrhage

Author

Henriquez, D.D.C.A., Caram-Deelder, C., Cessie, S. le, Zwart, J.J., Roosmalen, J.J.M. van, Eikenboom, J.C.J., So-Osman, C., Watering, L.G. van de, Zwaginga, J.J., Koopman-van Gemert, A.W.M.M., Bloemenkamp, K.W.M., Bom, J.G. van der, Bank, C.M.C., Snuif-de Lange, Y.S., Gammeren, A.J. van, Papatsonis, D.N.M., Klinkspoor, H., Kok, M., Boer, B.A. de, Langenveld, J., Leers, M.P.G., Diris, J.H.C., Kok, R.D., Engbers, P., Hanssen, M.J.C.P., Wijngaarden, W.J. van, Schippers, D.H., Stappen, J.J. van der, Hasaart, T.H.M., Kerkhof, D.H. van de, Kok, J.B. de, Unnik, G.A. van, Kortlandt, W., Schuitemaker, N.E., Delemarre, F.M.C., Duijnhoven, H.L.P. van, Duvekot, H.J., Hogenboom, S., Kleiverda, G., Etten-van Hulst, M.J.W. van, Mirani-Oostdijk, K.P., Kampen, C. van, Weinans, M.J.N., Adriaanse, H.J., Huisjes, A.J.M., Frasa, M.A.M., Keuren, J.F.W., Meir, C.A. van, Feitsma, H., Hudig, F., Sikkema, J.M., Baas, M.I., Fouraux, M.A., Hmetz, G.C., Bijvank, B.H.N., Rondeel, H.J.M., Roelofsen, J.M.T., Doesburg-van Kleffens, M., Wit, S.C. de, Versendaal, H., Weerkamp, F., Henskens, Y.M.C., Scheepers, L.H.C.J., Ham, D.P. van der, Smit, J.W., Graaf, F. van der, Porath, M.M., Salm, P.C.M. van der, Wijnen, M. van, Pontesilli, M., Dunne, F.M. van, Ponjee, G.A.E., Post, M.S., Veen, B.S. van der, Brons, J.T.J., Slomp, J., Mare, A. de, Leyte, A., Akker, E.S.A. van den, Wet, H. de, Borden, D.M.R. van der, Bremer, H.A., Tax, G.H.M., Vries, M.J. de, Boer, K. de, Waard, H. de, Keijzer, R.H. de, Burggraaff, J.M., Pouwels, J.G.J., Gemund, N. van, Prinzen, L., Hendriks, H.A., Hermsen, B.B.J., Koehorst, S.G.A., Verhagen, T.E.M., Beek, E. van, Hackeng, C.M., Kabel, P.J., Steures, P., Dooren, I.A. van, Michielse, E.C.H.J., Chon, H., Treskes, M., Visser, H., Oostenveld, E., Peters, D.H.M., Franssen, M.T.M., Meekers, J.H., Woiski, M.D., Pampus, L.C.M. van, Oudijk, M.A., Vooght, K.M.K. de, Cikot, R.L.M., Mostert, L.J., Ceelie, H., Huijssoon, A.M.G., Groot, C.J.M. de, Visser, O., Jonker, N., Koops, A., Hooker, A., Osmanovic, N., Ulenkate, H.J.L.M., Visschers, B., Martens, G.D.M., TeMpOH-Res Grp, Athena Institute, APH - Global Health, APH - Quality of Care, Reproductive Origins of Adult Health and Disease (ROAHD), Faculteit FHML Centraal, RS: CARIM - R1.04 - Clinical thrombosis and haemostasis, MUMC+: DA CDL Algemeen (9), Med Microbiol, Infect Dis & Infect Prev, Obstetrie & Gynaecologie, MUMC+: MA Medische Staf Obstetrie Gynaecologie (9), RS: GROW - R4 - Reproductive and Perinatal Medicine, RS: Carim - B04 Clinical thrombosis and Haemostasis, and Obstetrics & Gynecology

Subjects
Adult, medicine.medical_specialty, medicine.medical_treatment, TRACHEAL INTUBATION, Blood Component Transfusion, Time-to-Treatment, Cohort Studies, MULTIPLE IMPUTATION, DOUBLE-BLIND, Plasma, PROPENSITY SCORE ANALYSIS, SDG 3 - Good Health and Well-being, medicine, Coagulopathy, MANAGEMENT, Humans, Original Investigation, FIBRINOGEN CONCENTRATE, COAGULOPATHY, Hysterectomy, business.industry, Obstetrics, Incidence (epidemiology), Research, Incidence, Postpartum Hemorrhage, HOSPITAL CARDIAC-ARREST, Obstetrics and Gynecology, TRANEXAMIC ACID, General Medicine, Odds ratio, Puerperal Disorders, medicine.disease, Uterine atony, Online Only, BALANCE, Propensity score matching, Female, business, Cohort study
Abstract

This cohort study examines the association of timing of receipt of plasma transfusions among women experiencing persistent postpartum hemorrhage with adverse maternal outcomes., Key Points Question Is plasma transfusion within the first 60 minutes of persistent postpartum hemorrhage (PPH) associated with incidence of maternal adverse outcomes? Findings In this cohort study of 114 propensity score–matched women with persistent PPH, plasma transfusion within the first 60 minutes of persistent PPH was not associated with incidence of maternal adverse outcomes compared with no or later plasma transfusion, independent of severity of PPH at the time of plasma transfusion. Meaning These findings do not support the theory that early plasma transfusion in women with persistent PPH is better than no or later plasma transfusion., Importance Early plasma transfusion for women with severe postpartum hemorrhage (PPH) is recommended to prevent coagulopathy. However, there is no comparative, quantitative evidence on the association of early plasma transfusion with maternal outcomes. Objective To compare the incidence of adverse maternal outcomes among women who received plasma during the first 60 minutes of persistent PPH vs women who did not receive plasma for similarly severe persistent PPH. Design, Setting, and Participants This multicenter cohort study used a consecutive sample of women with persistent PPH, defined as PPH refractory to first-line measures to control bleeding, between January 1, 2011, and January 1, 2013. Time-dependent propensity score matching was used to select women who received plasma during the first 60 minutes of persistent PPH and match each of them with a woman who had shown the same severity and received the same treatment of PPH but who had not received plasma at the moment of matching. Transfusions were not guided by coagulation tests. Statistical analysis was performed from June 2018 to June 2019. Exposures Transfusion of plasma during the first 60 minutes of persistent PPH vs no or later plasma transfusion. Main Outcomes and Measures Incidence of adverse maternal outcomes, defined as a composite of death, hysterectomy, or arterial embolization. Results This study included 1216 women (mean [SD] age, 31.6 [5.0] years) with persistent PPH, of whom 932 (76.6%) delivered vaginally and 780 (64.1%) had PPH caused by uterine atony. Seven women (0.6%) died because of PPH, 62 women (5.1%) had a hysterectomy, and 159 women (13.1%) had arterial embolizations. Among women who received plasma during the first 60 minutes of persistent PPH, 114 women could be matched with a comparable woman who had not received plasma at the moment of matching. The incidence of adverse maternal outcomes was similar between the women, with adverse outcomes recorded in 24 women (21.2%) who received early plasma transfusion and 23 women (19.9%) who did not receive early plasma transfusion (odds ratio, 1.09; 95% CI, 0.57-2.09). Results of sensitivity analyses were comparable to the primary results. Conclusions and Relevance In this cohort study, initiation of plasma transfusion during the first 60 minutes of persistent PPH was not associated with adverse maternal outcomes compared with no or later plasma transfusion, independent of severity of PPH.

Published
2019
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12. Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with ‘refractoriness to treatment’: a cohort study

Author

Henriquez, D.D.C.A., Gillissen, A., Smith, S.M., Cramer, R.A., Akker, T. van den, Zwart, J.J., Roosmalen, J.J.M. van, Bloemenkamp, K.W.M., Bom, J.G. van der, Adriaanse, H.J., Akker, E.S.A. van den, Baas, M.I., Bank, C.M.C., Beek, E. van, Boer, B.A. de, Boer, K. de, Borden, D.M.R. van der, Bremer, H.A., Brons, J.T.J., Burggraaff, J.M., Ceelie, H., Chon, H., Cikot, J.L.M., Delemarre, F.M.C., Diris, J.H.C., Doesburg-van Kleffens, M., Dooren, I.M.A. van, Duijnhoven, J.L.P. van, Dunn, F.M. van, Duvekot, J.J., Engbers, P., Etten-van Hulst, M.J.W. van, Feitsma, H., Fouraux, M.A., Franssen, M.T.M., Frasa, M.A.M., Gammeren, A.J. van, Gemund, N. van, Graaf, F. van der, Groot, C.J.M. de, Hackeng, C.M., Ham, D.P. van der, Hanssen, M.J.C.P., Hasaart, T.H.M., Hendriks, H.A., Henskens, Y.M.C., Hermsen, B.B.J., Hogenboom, S., Hooker, A., Hudig, F., Huijssoon, A.M.G., Huisjes, A.J.M., Jonker, N., Kabel, P.J., Kampen, C. van, Keijzer, M.H. de, Kerkhof, D.H. van de, Keuren, J.F.W., Kleiverda, G., Klinkspoor, J.H., Koehorst, S.G.A., Kok, M., Kok, R.D., Kok, J.B. de, Koops, A., Kortlandt, W., Langenveld, J., Leers, M.P.G., Leyte, A., Mare, A. de, Martens, G.D.M., Meekers, J.H., Meir, C.A. van, Metz, G.C.H., Michielse, E.C.H.J., Mostert, L.J., Bijvank, S.W.H.N., Oostenveld, E., Osmanovic, N., Oudijk, M.A., Mirani-Oostdijk, C.P., Pampus, E.C.M. van, Papatsonis, D.N.M., Peters, R.H.M., Ponjee, G.A.E., Pontesilli, M., Porath, M.M., Post, M.S., Pouwels, J.G.J., Prinzen, L., Roelofsen, J.M.T., Rondeel, J.J.M., Salm, P.C.M. van der, Scheepers, H.C.J., Schippers, D.H., Schuitemaker, N.W.E., Sikkema, J.M., Slomp, J., Smit, J.W., Snuif-de Lange, Y.S., Stappen, J.W.J. van der, Steures, P., Tax, G.H.M., Treskes, M., Ulenkate, H.J.L.M., Unnik, G.A. van, Veen, B.S. van der, Verhagen, T.E.M., Versendaal, J., Visschers, B., Visser, O., Visser, H., Vooght, K.M.K. de, Vries, M.J. de, Waard, H. de, Weerkamp, F., Weinans, M.J.N., Wet, H. de, Wijnen, M. van, Wijngaarden, W.J. van, Wit, A.C. de, Woiski, M.D., TeMpOH-1 Study Grp, Obstetrics & Gynecology, Science Communication, APH - Global Health, Athena Institute, APH - Quality of Care, Reproductive Origins of Adult Health and Disease (ROAHD), Ethics, Law & Medical humanities, Cardiology, ACS - Heart failure & arrhythmias, Obstetrics and gynaecology, Amsterdam Reproduction & Development (AR&D), Pediatric surgery, Hematology, Faculteit FHML Centraal, RS: CARIM - R1.04 - Clinical thrombosis and haemostasis, MUMC+: DA CDL Algemeen (9), RS: GROW - R4 - Reproductive and Perinatal Medicine, MUMC+: MA Medische Staf Obstetrie Gynaecologie (9), Obstetrie & Gynaecologie, and RS: Carim - B04 Clinical thrombosis and Haemostasis

Subjects
Male, Blood transfusion, Refractory period, medicine.medical_treatment, 030204 cardiovascular system & hematology, Severity of Illness Index, law.invention, Postpartum haemorrhage, 0302 clinical medicine, law, Pregnancy, Risk Factors, Netherlands, 030219 obstetrics & reproductive medicine, Obstetrics, Incidence, Obstetrics and Gynecology, Prognosis, Intensive care unit, Embolization, Therapeutic, PREVALENCE, Survival Rate, Female, Cohort study, Research Article, Maternal mortality, Adult, medicine.medical_specialty, Reproductive medicine, Other Research Radboud Institute for Molecular Life Sciences [Radboudumc 0], Hysterectomy, lcsh:Gynecology and obstetrics, 03 medical and health sciences, All institutes and research themes of the Radboud University Medical Center, SDG 3 - Good Health and Well-being, medicine, Humans, Blood Transfusion, lcsh:RG1-991, Retrospective Studies, SEVERE MATERNAL MORBIDITY, business.industry, Other Research Radboud Institute for Health Sciences [Radboudumc 0], Postpartum Hemorrhage, Infant, Newborn, Retrospective cohort study, Definition, Packed red blood cells, business, Maternal morbidity, Follow-Up Studies
Abstract

Background The absence of a uniform and clinically relevant definition of severe postpartum haemorrhage hampers comparative studies and optimization of clinical management. The concept of persistent postpartum haemorrhage, based on refractoriness to initial first-line treatment, was proposed as an alternative to common definitions that are either based on estimations of blood loss or transfused units of packed red blood cells (RBC). We compared characteristics and outcomes of women with severe postpartum haemorrhage captured by these three types of definitions. Methods In this large retrospective cohort study in 61 hospitals in the Netherlands we included 1391 consecutive women with postpartum haemorrhage who received either ≥4 units of RBC or a multicomponent transfusion. Clinical characteristics and outcomes of women with severe postpartum haemorrhage defined as persistent postpartum haemorrhage were compared to definitions based on estimated blood loss or transfused units of RBC within 24 h following birth. Adverse maternal outcome was a composite of maternal mortality, hysterectomy, arterial embolisation and intensive care unit admission. Results One thousand two hundred sixty out of 1391 women (90.6%) with postpartum haemorrhage fulfilled the definition of persistent postpartum haemorrhage. The majority, 820/1260 (65.1%), fulfilled this definition within 1 h following birth, compared to 819/1391 (58.7%) applying the definition of ≥1 L blood loss and 37/845 (4.4%) applying the definition of ≥4 units of RBC. The definition persistent postpartum haemorrhage captured 430/471 adverse maternal outcomes (91.3%), compared to 471/471 (100%) for ≥1 L blood loss and 383/471 (81.3%) for ≥4 units of RBC. Persistent postpartum haemorrhage did not capture all adverse outcomes because of missing data on timing of initial, first-line treatment. Conclusion The definition persistent postpartum haemorrhage identified women with severe postpartum haemorrhage at an early stage of haemorrhage, unlike definitions based on blood transfusion. It also captured a large majority of adverse maternal outcomes, almost as large as the definition of ≥1 L blood loss, which is commonly applied as a definition of postpartum haemorrhage rather than severe haemorrhage.

Published
2019
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13. Fluid resuscitation during persistent postpartum haemorrhage and maternal outcome: A nationwide cohort study

Author

Henriquez, D.D.C.A., Bloemenkamp, K.W.M., Loeff, R.M., Zwart, J.J., Roosmalen, J.J.M. van, Zwaginga, J.J., Bom, J.G. van der, Adriaanse, H.J., Akker, E.S.A. van den, Baas, M.I., Bank, C.M.C., Beek, E. van, Boer, B.A. de, Boer, K. de, Borden, D.M.R. van der, Bremer, H.A., Brons, J.T.J., Burggraaff, J.M., Ceelie, H., Chon, H., Cikot, J.L.M., Delemarre, F.M.C., Diris, J.H.C., Doesburg-van Kleffens, M., Dooren, I.M.A. van, Duijnhoven, J.L.P. van, Dunne, F.M. van, Duvekot, J.J., Engbers, P., Hulst, M.J.W.V., Feitsma, H., Fouraux, M.A., Franssen, M.T.M., Frasa, M.A.M., Gammeren, A.J. van, Gemund, N. van, Graaf, F. van der, Groot, C.J.M. de, Hackeng, C.M., Ham, D.P. van der, Hanssen, M.J.C.P., Hasaart, T.H.M., Hendriks, H.A., Henskens, Y.M.C., Hermsen, B.B.J., Hogenboom, S., Hooker, A., Hudig, F., Huijssoon, A.M.G., Huisjes, A.J.M., Jonker, N., Kabel, P.J., Kampen, C. van, Keijzer, M.H. de, Kerkhof, D.H. van de, Keuren, J.F.W., Kleiverda, G., Klinkspoor, J.H., Koehorst, S.G.A., Kok, M., Kok, R.D., Kok, J.B. de, Koops, A., Kortlandt, W., Langenveld, J., Leers, M.P.G., Leyte, A., Mare, A. de, Martens, G.D.M., Meekers, J.H., Meir, C.A. van, Metz, G.C.H., Michielse, E.C.H.J., Mostert, L.J., Bijvank, S.W.H.N., Oostenveld, E., Osmanovic, N., Oudijk, M.A., Mirani-Oostdijk, C.P., Pampus, E.C.M. van, Papatsonis, D.N.M., Peters, R.H.M., Ponjee, G.A.E., Pontesilli, M., Porath, M.M., Post, M.S., Pouwels, J.G.J., Prinzen, L., Roelofsen, J.M.T., Rondeel, J.J.M., Salm, P.C.M. van der, Scheepers, H.C.J., Schippers, D.H., Schuitemaker, N.W.E., Sikkema, J.M., Slomp, J., Smit, J.W., Snuif-de Lange, Y.S., Stappen, J.W.J. van der, Steures, P., Tax, G.H.M., Treskes, M., Ulenkate, H.J.L.M., Unnik, G.A. van, Veen, B.S. van der, Verhagen, T.E.M., Versendaal, J., Visschers, B., Visser, O., Visser, H., Vooght, K.M.K. de, Vries, M.J. de, Waard, H. de, Weerkamp, F., Weinans, M.J.N., Wet, H. de, Wijnen, M. van, Wijngaarden, W.J. van, Wit, A.C. de, Woiski, M.D., TeMpOH-Study Grp, APH - Quality of Care, APH - Global Health, Obstetrics & Gynecology, RS: CARIM - R1.04 - Clinical thrombosis and haemostasis, MUMC+: DA CDL Algemeen (9), Faculteit FHML Centraal, RS: Carim - B04 Clinical thrombosis and Haemostasis, Reproductive Origins of Adult Health and Disease (ROAHD), and Athena Institute

Subjects
Adult, medicine.medical_specialty, Resuscitation, Blood transfusion, medicine.medical_treatment, CRYSTALLOIDS, Postpartum haemorrhage, 03 medical and health sciences, RED-BLOOD-CELLS, 0302 clinical medicine, SDG 3 - Good Health and Well-being, Interquartile range, Pregnancy, ERYTHROCYTES, medicine, Humans, Crystalloid solutions, 030212 general & internal medicine, Colloids, THROMBIN GENERATION, Netherlands, Retrospective Studies, COAGULOPATHY, 030219 obstetrics & reproductive medicine, Obstetrics, business.industry, Postpartum Hemorrhage, Obstetrics and Gynecology, Retrospective cohort study, Odds ratio, Confidence interval, Treatment Outcome, Reproductive Medicine, Fluid Therapy, TRAUMA PATIENTS, Female, Packed red blood cells, business, Cohort study
Abstract

Objective: To determine the association between increasing volumes of crystalloids and colloids administered before transfusion of packed red blood cells in women with persistent postpartum haemorrhage and adverse maternal outcomes. Study design: Retrospective cohort study in the Netherlands. Women with persistent postpartum haemorrhage and known clear fluids volume for resuscitation were included. Women who received ≤2 L of clear fluids were the reference group. We determined the effect of every additional litre of clear fluids on total blood loss, severe maternal morbidity and mortality. Results were adjusted for patient and bleeding characteristics. Results: Of the 883 included women, 199 received ≤2 L of clear fluids. Median blood loss for the reference group was 2.9 L (interquartile range 2.2–3.4). Adjusted mean difference in blood loss compared with the reference group was 0.2 L (95% confidence interval −0.1 to 0.5) for women in the >2 to ≤3 L, 0.4 L (0.1–0.7) for the >3 to ≤4 L category, 0.6 L (0.5–0.7) for the >4 to ≤5 L category, and 1.9 L (1.5–2.3) for the >5 to ≤7 L category. Adjusted odds ratios for adverse maternal outcomes were 1.0 (0.7–1.6), 1.2 (0.8–1.9), 1.8 (1.1–3.1) and 4.4 (2.6–7.5) for women in the 2 to ≤3 L category, >3 to ≤4 L, >4 to ≤5 L, and >5 to ≤7 L volume categories respectively. Results were similar in strata of different severities of bleeding. Conclusion: Clear fluids volume >4 L was independently associated with adverse maternal outcome in women with persistent postpartum haemorrhage.

Published
2019
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15. Body weight is negatively associated with direct oral anticoagulant trough concentrations in dabigatran and apixaban users

Author

Borst, J.M. (Jacqueline M.), Rein, N. (Nienke) van, Bakker, E.C.M.D. (Emilie C. M. D.), Vukadin, N. (Nikola), Rier, M. (Mike), Mairuhu, A.T.A., Hudig, F. (Francisca), Bosma, L.B.E. (Liesbeth B. E.), Wilms, E.B. (Erik B.), Visser, L.E. (Loes E.), Borst, J.M. (Jacqueline M.), Rein, N. (Nienke) van, Bakker, E.C.M.D. (Emilie C. M. D.), Vukadin, N. (Nikola), Rier, M. (Mike), Mairuhu, A.T.A., Hudig, F. (Francisca), Bosma, L.B.E. (Liesbeth B. E.), Wilms, E.B. (Erik B.), and Visser, L.E. (Loes E.)

Published
2020
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19. Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with 'refractoriness to treatment': a cohort study

Author

Henriquez, D., Gillissen, A., Smith, S.M., Cramer, R.A., van den Akker, T., Zwart, J.J. (Joost), van Roosmalen, J.J., Bloemenkamp, KW, Bom, J.G., Adriaanse, H.J., van den Akker, E.S.A., Baas, M.I., Bank, C.M.C., Beek, E. van, de Boer, B.A.G., Boer, K. (Karin), van der Borden, D.M.R., Bremer, H.A. (Henk), Brons, J.T.J., Burggraaff, J.M. (Jan), Ceelie, H., Chon, H., Cikot, J.L.M., Delemarre, F.M.C., Diris, J.H.C., Doesburg-van Kleffens, M., van Dooren, I.M.A., van Duijnhoven, J.L.P., van Dunn, F.M., Duvekot, J.J. (Hans), Engbers, P., van Hulst, M.J.W., Feitsma, H., Fouraux, M.A., Franssen, MT, Frasa, M.A.M., van Gammeren, A.J., Gemund, N. (Nicolette) van, van der Graaf, F., Groot, C.J.M., Hackeng, C.M. (Christian), Ham, D.P. (David) van der, Hanssen, M., Hasaart, T.H.M. (Tom), Hendriks, H.A., Henskens, Y.M.C., Hermsen, B.B.J., Hogenboom, S., Hooker, A., Hudig, F, Huijssoon, A.G. (Annemarie), Huisjes, A.J.M. (Anjoke), Jonker, N., Kabel, P.J., van Kampen, C., de Keijzer, M.H., van de Kerkhof, D.H., Keuren, JFW, Kleiverda, G., Klinkspoor, J.H., Koehorst, S.G.A., Kok, M.O. (Maarten), Kok, R.D., Kok, J.B. (Jacques) de, Koops, A., Kortlandt, W. (Wouter), Langenveld, J. (J.), Leers, MPG, Leyte, A. (Anja), de Mare, A., Martens, G.D.M., Meekers, J.H., Meir, C.A. (Claudia) van, Metz, G.C.H. (Godfried), Michielse, E., Mostert, L.J., Bijvank, S., Oostenveld, E., Osmanovic, N., Oudijk, M.A. (Martijn), Mirani-Oostdijk, C.P., van Pampus, E. C. M., Papatsonis, D.N.M. (Dimitri), Peters, R.H.M., Ponjee, G.A.E. (Gabriëlle), Pontesilli, M., Porath, M. (Martina), Post, M.S., Pouwels, J.G.J., Prinzen, L., Roelofsen, J.M.T., Rondeel, J.J.M., Salm, P.C.M. (Paulien) van der, Scheepers, H.C.J. (Hubertina), Schippers, D.H. (Daniela), Schuitemaker, N.W.E. (Nico), Sikkema, J.M. (J. Marko), Slomp, J. (Jennita), Smit, J.W.A. (Jan), Snuif-de Lange, Y.S., van der Stappen, J.W.J., Steures, P. (Pieternel), Tax, G.H.M., Treskes, M., Ulenkate, H., van Unnik, G.A., van der Veen, B.S., Verhagen, T.E.M., Versendaal, J. (Johan), Visschers, B., Visser, O. (Oane), de Visser, H., De Vooght, KMK, de Vries, M.J., Waard, H. (Harm) de, Weerkamp, F. (Floor), Weinans, M.J.N. (Martin), de Wet, H., Wijnen, M. (Marit), Wijngaarden, W.J. (Wim) van, de Wit, A.C., Woiski, M.D. (Mallory), TeMp, O.H.S.G., Henriquez, D., Gillissen, A., Smith, S.M., Cramer, R.A., van den Akker, T., Zwart, J.J. (Joost), van Roosmalen, J.J., Bloemenkamp, KW, Bom, J.G., Adriaanse, H.J., van den Akker, E.S.A., Baas, M.I., Bank, C.M.C., Beek, E. van, de Boer, B.A.G., Boer, K. (Karin), van der Borden, D.M.R., Bremer, H.A. (Henk), Brons, J.T.J., Burggraaff, J.M. (Jan), Ceelie, H., Chon, H., Cikot, J.L.M., Delemarre, F.M.C., Diris, J.H.C., Doesburg-van Kleffens, M., van Dooren, I.M.A., van Duijnhoven, J.L.P., van Dunn, F.M., Duvekot, J.J. (Hans), Engbers, P., van Hulst, M.J.W., Feitsma, H., Fouraux, M.A., Franssen, MT, Frasa, M.A.M., van Gammeren, A.J., Gemund, N. (Nicolette) van, van der Graaf, F., Groot, C.J.M., Hackeng, C.M. (Christian), Ham, D.P. (David) van der, Hanssen, M., Hasaart, T.H.M. (Tom), Hendriks, H.A., Henskens, Y.M.C., Hermsen, B.B.J., Hogenboom, S., Hooker, A., Hudig, F, Huijssoon, A.G. (Annemarie), Huisjes, A.J.M. (Anjoke), Jonker, N., Kabel, P.J., van Kampen, C., de Keijzer, M.H., van de Kerkhof, D.H., Keuren, JFW, Kleiverda, G., Klinkspoor, J.H., Koehorst, S.G.A., Kok, M.O. (Maarten), Kok, R.D., Kok, J.B. (Jacques) de, Koops, A., Kortlandt, W. (Wouter), Langenveld, J. (J.), Leers, MPG, Leyte, A. (Anja), de Mare, A., Martens, G.D.M., Meekers, J.H., Meir, C.A. (Claudia) van, Metz, G.C.H. (Godfried), Michielse, E., Mostert, L.J., Bijvank, S., Oostenveld, E., Osmanovic, N., Oudijk, M.A. (Martijn), Mirani-Oostdijk, C.P., van Pampus, E. C. M., Papatsonis, D.N.M. (Dimitri), Peters, R.H.M., Ponjee, G.A.E. (Gabriëlle), Pontesilli, M., Porath, M. (Martina), Post, M.S., Pouwels, J.G.J., Prinzen, L., Roelofsen, J.M.T., Rondeel, J.J.M., Salm, P.C.M. (Paulien) van der, Scheepers, H.C.J. (Hubertina), Schippers, D.H. (Daniela), Schuitemaker, N.W.E. (Nico), Sikkema, J.M. (J. Marko), Slomp, J. (Jennita), Smit, J.W.A. (Jan), Snuif-de Lange, Y.S., van der Stappen, J.W.J., Steures, P. (Pieternel), Tax, G.H.M., Treskes, M., Ulenkate, H., van Unnik, G.A., van der Veen, B.S., Verhagen, T.E.M., Versendaal, J. (Johan), Visschers, B., Visser, O. (Oane), de Visser, H., De Vooght, KMK, de Vries, M.J., Waard, H. (Harm) de, Weerkamp, F. (Floor), Weinans, M.J.N. (Martin), de Wet, H., Wijnen, M. (Marit), Wijngaarden, W.J. (Wim) van, de Wit, A.C., Woiski, M.D. (Mallory), and TeMp, O.H.S.G.

Abstract

Background: The absence of a uniform and clinically relevant definition of severe postpartum haemorrhage hampers comparative studies and optimization of clinical management. The concept of persistent postpartum haemorrhage, based on refractoriness to initial first-line treatment, was proposed as an alternative to common definitions that are either based on estimations of blood loss or transfused units of packed red blood cells (RBC). We compared characteristics and outcomes of women with severe postpartum haemorrhage captured by these three types of definitions. Methods: In this large retrospective cohort study in 61 hospitals in the Netherlands we included 1391 consecutive women with postpartum haemorrhage who received either ≥4 units of RBC or a multicomponent transfusion. Clinical characteristics and outcomes of women with severe postpartum haemorrhage defined as persistent postpartum haemorrhage were compared to definitions based on estimated blood loss or transfused units of RBC within 24 h following birth. Adverse maternal outcome was a composite of maternal mortality, hysterectomy, arterial embolisation and intensive care unit admission. Results: One thousand two hundred sixty out of 1391 women (90.6%) with postpartum haemorrhage fulfilled the definition of persistent postpartum haemorrhage. The majority, 820/1260 (65.1%), fulfilled this definition within 1 h following birth, compared to 819/1391 (58.7%) applying the definition of ≥1 L blood loss and 37/845 (4.4%) applying the definition of ≥4 units of RBC. The definition persistent postpartum haemorrhage captured 430/471 adverse maternal outcomes (91.3%), compared to 471/471 (100%) for ≥1 L blood loss and 383/471 (81.3%) for ≥4 units of RBC. Persiste

Published
2019
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20. Clinical characteristics of women captured by extending the definition of severe postpartum haemorrhage with 'refractoriness to treatment': a cohort study

Author

Henriquez, D, Gillissen, A, Smith, SM, Cramer, RA, van den Akker, T, Zwart, JJ, van Roosmalen, JJ, Bloemenkamp, KW, Bom, JG, Adriaanse, HJ, Akker, ESA, Baas, MI, Bank, CMC, Beek, E, de Boer, BAG, Boer, K, van der Borden, DMR, Bremer, HA, Brons, JTJ, Burggraaff, JM, Ceelie, H, Chon, H, Cikot, JLM, Delemarre, FMC, Diris, JHC, Doesburg-van Kleffens, M, van Dooren, IMA, van Duijnhoven, JLP, van Dunn, FM, Duvekot, J.J., Engbers, P, Hulst, MJW, Feitsma, H, Fouraux, MA, Franssen, MT, Frasa, MAM, van Gammeren, AJ, Gemund, N, Graaf, F, Groot, CJM, Hackeng, CM, van der Ham, DP, Hanssen, M, Hasaart, THM, Hendriks, HA, Henskens, YMC, Hermsen, BBJ, Hogenboom, S, Hooker, A, Hudig, F, Huijssoon, AMG, Huisjes, AJM, Jonker, N, Kabel, PJ, van Kampen, C, de Keijzer, MH, van de Kerkhof, DH, Keuren, JFW, Kleiverda, G, Klinkspoor, JH, Koehorst, SGA, Kok, M, Kok, RD, de Kok, JB, Koops, A, Kortlandt, W, Langenveld, J, Leers, MPG, Leyte, A, de Mare, A, Martens, GDM, Meekers, JH, van Meir, CA, Metz, GCH, Michielse, E, Mostert, LJ, Bijvank, S, Oostenveld, E, Osmanovic, N, Oudijk, MA, Mirani-Oostdijk, CP, van Pampus, E C M, Papatsonis, DNM, Peters, RHM, Ponjee, GA, Pontesilli, M, Porath, MM, Post, MS, Pouwels, JGJ, Prinzen, L, Roelofsen, JMT, Rondeel, JJM, van der Salm, PCM, Scheepers, HCJ, Schippers, DH, Schuitemaker, NWE, Sikkema, JM, Slomp, J, Smit, JWA, Snuif-de Lange, YS, van der Stappen, JWJ, Steures, P, Tax, GHM, Treskes, M, Ulenkate, H, van Unnik, GA, van der Veen, BS, Verhagen, TEM, Versendaal, J, Visschers, B, Visser, O, Visser, H, De Vooght, KMK, Vries, MJ, Waard, H, Weerkamp, F, Weinans, MJN, de Wet, H, Wijnen, M (Mandy), van Wijngaarden, WJ, de Wit, AC, Woiski, MD, TeMp, OHSG, Henriquez, D, Gillissen, A, Smith, SM, Cramer, RA, van den Akker, T, Zwart, JJ, van Roosmalen, JJ, Bloemenkamp, KW, Bom, JG, Adriaanse, HJ, Akker, ESA, Baas, MI, Bank, CMC, Beek, E, de Boer, BAG, Boer, K, van der Borden, DMR, Bremer, HA, Brons, JTJ, Burggraaff, JM, Ceelie, H, Chon, H, Cikot, JLM, Delemarre, FMC, Diris, JHC, Doesburg-van Kleffens, M, van Dooren, IMA, van Duijnhoven, JLP, van Dunn, FM, Duvekot, J.J., Engbers, P, Hulst, MJW, Feitsma, H, Fouraux, MA, Franssen, MT, Frasa, MAM, van Gammeren, AJ, Gemund, N, Graaf, F, Groot, CJM, Hackeng, CM, van der Ham, DP, Hanssen, M, Hasaart, THM, Hendriks, HA, Henskens, YMC, Hermsen, BBJ, Hogenboom, S, Hooker, A, Hudig, F, Huijssoon, AMG, Huisjes, AJM, Jonker, N, Kabel, PJ, van Kampen, C, de Keijzer, MH, van de Kerkhof, DH, Keuren, JFW, Kleiverda, G, Klinkspoor, JH, Koehorst, SGA, Kok, M, Kok, RD, de Kok, JB, Koops, A, Kortlandt, W, Langenveld, J, Leers, MPG, Leyte, A, de Mare, A, Martens, GDM, Meekers, JH, van Meir, CA, Metz, GCH, Michielse, E, Mostert, LJ, Bijvank, S, Oostenveld, E, Osmanovic, N, Oudijk, MA, Mirani-Oostdijk, CP, van Pampus, E C M, Papatsonis, DNM, Peters, RHM, Ponjee, GA, Pontesilli, M, Porath, MM, Post, MS, Pouwels, JGJ, Prinzen, L, Roelofsen, JMT, Rondeel, JJM, van der Salm, PCM, Scheepers, HCJ, Schippers, DH, Schuitemaker, NWE, Sikkema, JM, Slomp, J, Smit, JWA, Snuif-de Lange, YS, van der Stappen, JWJ, Steures, P, Tax, GHM, Treskes, M, Ulenkate, H, van Unnik, GA, van der Veen, BS, Verhagen, TEM, Versendaal, J, Visschers, B, Visser, O, Visser, H, De Vooght, KMK, Vries, MJ, Waard, H, Weerkamp, F, Weinans, MJN, de Wet, H, Wijnen, M (Mandy), van Wijngaarden, WJ, de Wit, AC, Woiski, MD, and TeMp, OHSG

Published
2019

21. Age of platelet concentrates and time to the next transfusion

Author

Caram-Deelder, C., Bom, J.G. van der, Putter, H., Leyte, A., Kerkhof, D. van de, Evers, D., Beckers, E.A., Weerkamp, F., Hudig, F., Zwaginga, J.J., Rondeel, J.M.M., Vooght, K.M.K. de, Pequeriaux, N.C.V., Visser, O., Wallis, J.P., and Middelburg, R.A.

Subjects
Vascular damage Radboud Institute for Health Sciences [Radboudumc 16]
Abstract

Item does not contain fulltext BACKGROUND: Storage time of platelet (PLT) concentrates has been negatively associated with clinical efficacy outcomes. The aim of this study was to quantify the association between storage time of PLT concentrates and interval to the next PLT transfusion for different types of PLT components, stored for up to 7 days and transfused to transfusion-dependent hematooncology patients with thrombocytopenia. STUDY DESIGN AND METHODS: From a cohort of patients from 10 major Dutch hospitals, patients were selected whose transfusion patterns were compatible with PLT transfusion dependency due to hematooncologic disease. Mean time to the next transfusion and mean differences in time to the next transfusion for different storage time categories (i.e., fresh, 5 days) were estimated, per component type, using multilevel mixed-effects linear models. RESULTS: Among a cohort of 29,761 patients who received 140,896 PLT transfusions we selected 4441 hematooncology patients who had received 12,724 PLT transfusions during periods of PLT transfusion dependency. Transfusion of fresh, compared to old, buffy coat-derived PLTs in plasma was associated with a delay to the next transfusion of 6.2 hours (95% confidence interval [CI], 4.5-8.0 hr). For buffy coat-derived PLTs in PAS-B and -C this difference was 7.7 hours (95% CI, 2.2-13.3 hr) and 3.9 hours (95% CI, -2.1 to 9.9 hr) while for apheresis PLTs in plasma it was only 1.8 hours (95% CI, -3.5 to 7.1 hr). CONCLUSION: Our results indicate that the time to the next transfusion shortens with increasing age of transfused buffy coat-derived PLT concentrates. This association was not observed for apheresis PLTs.

Published
2018

34. Absence of the spleen and the occurrence of primary red cell alloimmunization in humans

Author

Evers, D., Bom, J.G. Van Der, Tijmensen, J., Haas, M. de, Middelburg, R.A., Vooght, K.M. De, Kerkhof, D. van de, Visser, O, Pequeriaux, N.C.V., Hudig, F., Zwaginga, J.J., Evers, D., Bom, J.G. Van Der, Tijmensen, J., Haas, M. de, Middelburg, R.A., Vooght, K.M. De, Kerkhof, D. van de, Visser, O, Pequeriaux, N.C.V., Hudig, F., and Zwaginga, J.J.

Abstract

Contains fulltext : 177223.pdf (publisher's version ) (Open Access)

Published
2017

35. Treatments for hematologic malignancies in contrast to those for solid cancers are associated with reduced red cell alloimmunization

Author

Evers, D., Zwaginga, J.J., Tijmensen, J., Middelburg, R.A., Haas, M. de, Vooght, K.M. De, Kerkhof, D. van de, Visser, O, Pequeriaux, N.C.V., Hudig, F., Bom, J.G. Van Der, Evers, D., Zwaginga, J.J., Tijmensen, J., Middelburg, R.A., Haas, M. de, Vooght, K.M. De, Kerkhof, D. van de, Visser, O, Pequeriaux, N.C.V., Hudig, F., and Bom, J.G. Van Der

Abstract

Contains fulltext : 169863.pdf (publisher's version ) (Open Access), Red cell alloimmunization may induce severe hemolytic side effects. Identification of risk-modifying conditions will help tailor preventative strategies. This study aims to quantify the associations of hematologic malignancies and solid cancers with red cell alloimmunization in patients receiving red cell transfusions. We performed a nested multicenter case-control study in a source population of 24,063 patients receiving their first and subsequent red cell transfusions during an 8-year follow-up period. Cases (n=505), defined as patients developing a first transfusion-induced red cell alloantibody, were each compared with 2 non-alloimmunized controls (n=1010) who received a similar number of red cell units. Using multivariate logistic regression analyses, we evaluated the association of various malignancies and treatment regimens with alloimmunization during a delineated 5-week risk period. The incidence of alloimmunization among patients with acute (myeloid or lymphoid) leukemia and mature (B- or T-cell) lymphoma was significantly reduced compared to patients without these malignancies: adjusted relative risks (RR) with 95% confidence interval (CI) 0.36 (range 0.19-0.68) and 0.30 (range 0.12-0.81). Associations were primarily explained by immunosuppressive treatments [RR for (any type of) chemotherapy combined with immunotherapy 0.27 (95%CI: 0.09-0.83)]. Alloimmunization risks were similarly diminished in allogeneic or autologous stem cell transplanted patients (RR 0.34, 95%CI: 0.16-0.74), at least during the six months post transplant. Alloimmunization risks of patients with other hematologic diseases or solid cancers, and their associated treatment regimens were similar to risks in the general transfused population. Our findings suggest that, in contrast to malignancies in general, hemato-oncological patients treated with dose-intensive regimens have strongly diminished risk of red cell alloimmunization.

Published
2017

36. Age of platelet concentrates and time to the next transfusion

Author

Caram-Deelder, C. (Camila), Bom, J.G. (Anske) van der, Putter, H. (Hein), Leyte, A. (Anja), Kerkhof, D.v.d. (Daan van de), Evers, D. (Dorothea), Beckers, E.A.M. (Erik), Weerkamp, F. (Floor), Hudig, F. (Francisca), Zwaginga, J.J. (Jaap), Rondeel, J.M.M. (Jan), de Vooght, K.M. (Karen M.K.), Pe´que´riaux, N.C. (Nathalie C.V.), Visser, O.J. (Otto), Wallis, J.P. (Jonathan P.), Middelburg, R.A. (Rutger A.), Caram-Deelder, C. (Camila), Bom, J.G. (Anske) van der, Putter, H. (Hein), Leyte, A. (Anja), Kerkhof, D.v.d. (Daan van de), Evers, D. (Dorothea), Beckers, E.A.M. (Erik), Weerkamp, F. (Floor), Hudig, F. (Francisca), Zwaginga, J.J. (Jaap), Rondeel, J.M.M. (Jan), de Vooght, K.M. (Karen M.K.), Pe´que´riaux, N.C. (Nathalie C.V.), Visser, O.J. (Otto), Wallis, J.P. (Jonathan P.), and Middelburg, R.A. (Rutger A.)

Abstract

BACKGROUND: Storage time of platelet (PLT) concentrates has been negatively associated with clinical efficacy outcomes. The aim of this study was to quantify the association between storage time of PLT concentrates and interval to the next PLT transfusion for different types of PLT components, stored for up to 7 days and transfused to transfusion-dependent hematooncology patients with thrombocytopenia. STUDY DESIGN AND METHODS: From a cohort of patients from 10 major Dutch hospitals, patients were selected whose transfusion patterns were compatible with PLT transfusion dependency due to hematooncologic disease. Mean time to the next transfusion and mean differences in time to the next transfusion for different

Published
2017
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37. Association of Blood Transfusion From Female Donors With and Without a History of Pregnancy With Mortality Among Male and Female Transfusion Recipients

Author

Caram-Deelder, C., Kreuger, A.L., Evers, D., Vooght, K.M. De, Kerkhof, D. van de, Visser, O, Pequeriaux, N.C.V., Hudig, F., Zwaginga, J.J., Bom, J.G. van der, Middelburg, R.A., Caram-Deelder, C., Kreuger, A.L., Evers, D., Vooght, K.M. De, Kerkhof, D. van de, Visser, O, Pequeriaux, N.C.V., Hudig, F., Zwaginga, J.J., Bom, J.G. van der, and Middelburg, R.A.

Abstract

Item does not contain fulltext, Importance: Transfusion of red blood cells from female donors has been associated with increased mortality in male recipients. Objective: To quantify the association between red blood cell transfusion from female donors with and without a history of pregnancy and mortality of red blood cell recipients. Design, Setting, and Participants: Retrospective cohort study of first-time transfusion recipients at 6 major Dutch hospitals enrolled from May 30, 2005, to September 1, 2015; the final follow-up date was September 1, 2015. The primary analysis was the no-donor-mixture cohort (ie, either all red blood cell transfusions exclusively from male donors, or all exclusively from female donors without a history of pregnancy, or all exclusively from female donors with a history of pregnancy). The association between mortality and exposure to transfusions from ever-pregnant or never-pregnant female donors was analyzed using life tables and time-varying Cox proportional hazards models. Exposures: Red blood cell transfusions from ever-pregnant or never-pregnant female donors, compared with red blood cell transfusions from male donors. Main Outcomes and Measures: All-cause mortality during follow-up. Results: The cohort for the primary analyses consisted of 31118 patients (median age, 65 [interquartile range, 42-77] years; 52% female) who received 59320 red blood cell transfusions exclusively from 1 of 3 types of donors (88% male; 6% ever-pregnant female; and 6% never-pregnant female). The number of deaths in this cohort was 3969 (13% mortality). For male recipients of red blood cell transfusions, all-cause mortality rates after a red blood cell transfusion from an ever-pregnant female donor vs male donor were 101 vs 80 deaths per 1000 person-years (time-dependent "per transfusion" hazard ratio [HR] for death, 1.13 [95% CI, 1.01-1.26]). For receipt of transfusion from a never-pregnant female donor vs male donor, mortality rates were 78 vs 80 deaths per 1000 person-years (HR, 0.93

Published
2017

38. Red cell alloimmunisation in patients with different types of infections.

Author

Evers, D., Bom, J.G. Van Der, Tijmensen, J., Middelburg, R.A., Haas, M. de, Zalpuri, S., Vooght, K.M. De, Kerkhof, D. van de, Visser, O, Pequeriaux, N.C.V., Hudig, F., Zwaginga, J.J., Evers, D., Bom, J.G. Van Der, Tijmensen, J., Middelburg, R.A., Haas, M. de, Zalpuri, S., Vooght, K.M. De, Kerkhof, D. van de, Visser, O, Pequeriaux, N.C.V., Hudig, F., and Zwaginga, J.J.

Abstract

1 december 2016, Contains fulltext : 166311.pdf (publisher's version ) (Open Access), Red cell alloantigen exposure can cause alloantibody-associated morbidity. Murine models have suggested that inflammation modulates red cell alloimmunisation. This study quantifies alloimmunisation risks during infectious episodes in humans. We performed a multicentre case-control study within a source population of patients receiving their first and subsequent red cell transfusions during an 8-year follow-up period. Patients developing a first transfusion-induced red cell alloantibody (N = 505) were each compared with two similarly exposed, but non-alloimmunised controls (N = 1010) during a 5-week 'alloimmunisation risk period' using multivariate logistic regression analysis. Transfusions during 'severe' bacterial (tissue-invasive) infections were associated with increased risks of alloantibody development [adjusted relative risk (RR) 1.34, 95% confidence interval (95% CI) 0.97-1.85], especially when these infections were accompanied with long-standing fever (RR 3.06, 95% CI 1.57-5.96). Disseminated viral disorders demonstrated a trend towards increased risks (RR 2.41, 95% CI 0.89-6.53), in apparent contrast to a possible protection associated with Gram-negative bacteraemia (RR 0.58, 95% CI 0.13-1.14). 'Simple' bacterial infections, Gram-positive bacteraemia, fungal infections, maximum C-reactive protein values and leucocytosis were not associated with red cell alloimmunisation. These findings are consistent with murine models. Confirmatory research is needed before patients likely to develop alloantibodies may be identified based on their infectious conditions at time of transfusion.

Published
2016

39. Red-blood-cell alloimmunisation in relation to antigens' exposure and their immunogenicity: a cohort study.

Author

Evers, D., Middelburg, R.A., Haas, M. de, Zalpuri, S., Vooght, K.M. De, Kerkhof, D. van de, Visser, O, Pequeriaux, N.C.V., Hudig, F., Schonewille, H., Zwaginga, J.J., Bom, J.G. Van Der, Evers, D., Middelburg, R.A., Haas, M. de, Zalpuri, S., Vooght, K.M. De, Kerkhof, D. van de, Visser, O, Pequeriaux, N.C.V., Hudig, F., Schonewille, H., Zwaginga, J.J., and Bom, J.G. Van Der

Abstract

1 juni 2016, Item does not contain fulltext, BACKGROUND: Matching donor red blood cells based on recipient antigens prevents alloimmunisation. Knowledge about the immunogenicity of red-blood-cell antigens can help optimise risk-adapted matching strategies. We set out to assess the immunogenicity of red-blood-cell antigens. METHODS: In an incident new-user cohort of previously non-transfused, non-alloimmunised white patients receiving non-extended matched red-blood-cell transfusions in six Dutch hospitals between 2006 and 2013, we determined the cumulative number of mismatched red-blood-cell units per patient. We used multiple imputation to address missing antigen data. Using Kaplan-Meier analysis, we estimated cumulative alloimmunisation incidences per mismatched antigen dose as a measure of immunogenicity. FINDINGS: Of 54 347 patients assessed, 21 512 were included in our study. Alloantibodies occurred in 474 (2.2%) of all transfused patients, with cumulative alloimmunisation incidences increasing up to 7.7% (95% CI 4.9-11.2) after 40 units received. The antigens C, c, E, K, and Jk(a) were responsible for 78% of all alloimmunisations in our cohort. K, E, and C(w) were the most immunogenic antigens (cumulative immunisation incidences after 2 mismatched units of 2.3% [95% CI 1.0-4.8] for K, 1.5% [0.6-3.0] for E, and 1.2% [0.0-10.8] for C(w)). These antigens were 8.7 times (for K), 5.4 times (for E), and 4.6 times (for C(w)) as immunogenic as Fy(a). The next most immunogenic antigens were, in order, e (1.9 times as immunogenic as Fy(a)), Jk(a) (1.9 times), and c (1.6 times). INTERPRETATION: Red-blood-cell antigens vary in their potency to evoke a humoral immune response. Our findings highlight that donor-recipient red-blood-cell matching strategies will be most efficient when primarily focusing on prevention of C, c, E, K, and Jk(a) alloimmunisation. Matching for Fy(a) is of lower clinical relevance. Variations of antigen frequencies determined by ethnic background prevent extrapolating these conclusions to non

Published
2016

46. Transfusion of ever-pregnant donor red blood cells and mortality of male patients.

Author

Valk SJ, Caram-Deelder C, Groenwold RHH, Evers D, De Vooght KMK, Van de Kerkhof D, Wondergem MJ, Péquériaux NCV, Hudig F, Zwaginga JJ, Middelburg RA, and Van der Bom JG

Subjects
Humans, Male, Female, Adult, Middle Aged, Pregnancy, Adolescent, Young Adult, Netherlands epidemiology, Sex Factors, Aged, Blood Donors, Erythrocyte Transfusion adverse effects, Erythrocyte Transfusion mortality
Abstract

Previous studies found exposure to red blood cell transfusions from female donors who have been pregnant reduces survival in male patients compared to exposure to male donor products, but evidence is not consistent. We postulate the previously observed association is modified by offspring sex, with an expected increased mortality risk for male patients receiving units from female donors with sons. Here, marginal structural models were used to assess the association between exposure to units from ever-pregnant donors, ever-pregnant donors with sons and ever-pregnant donors with daughters, and mortality. Clinical data were collected on first-ever transfusion recipients in the Netherlands and donor data were supplemented with information about offspring sex and date of birth. In this analysis, 56,825 patients were included, of whom 8,288 died during follow-up. Exposure to red blood cell units from ever-pregnant donors with sons was not associated with increased all-cause mortality risk among male transfusion recipients (hazard ratio [HR]=0.91, 95% confidence interval [CI]: 0.83-1.01). Exposure to ever-pregnant donors, irrespective of offspring sex, was associated with mortality in male patients aged between 18 and 50 years (ever-pregnant donors: HR=1.81, 95% CI: 1.31-2.51) compared to male donor units, but was protective in female patients. This study suggests that the observed increased mortality risk for exposure to red blood cell units from parous female donors does not depend on offspring sex. The increased risk of mortality seen in younger adult male patients is consistent with previous observations, but the underlying biological mechanism could not be identified in this study.

Published
2024
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47. Challenging the dogma: Red blood cell-directed autoimmunity as risk factor for red blood cell alloimmunisation after blood transfusion.

Author

Oud JA, de Haas M, de Vooght KMK, van de Kerkhof D, Som N, Péquériaux NCV, Hudig F, van der Bom JG, Evers D, and Zwaginga JJ

Subjects
Humans, Female, Male, Middle Aged, Risk Factors, Adult, Aged, Coombs Test, Case-Control Studies, Isoantibodies blood, Isoantibodies immunology, Blood Group Incompatibility immunology, Transfusion Reaction immunology, Transfusion Reaction blood, Transfusion Reaction etiology, Autoimmunity, Erythrocytes immunology, Erythrocyte Transfusion adverse effects
Abstract

Red blood cell autoimmunity and alloimmunity are potentially linked. Quantification of this association can tailor extensively matched red blood cell transfusions in patients with autoimmunity. Using an incident new-user cohort comprising 47 285 previously non-transfused, non-alloimmunised patients, we compared transfusion-induced red blood cell alloimmunisation incidences in direct antiglobulin test (DAT)-positive and control patients. Additionally, we performed case-control analyses to handle potential confounding by clinical immunomodulators. Among (IgG and/or C3d) DAT-positive patients (N = 380), cumulative red blood cell alloimmunisation incidences after 10 units transfused reached 4.5% (95% confidence interval [CI] 2.5-8.2) versus 4.2% (CI 3.9-4.5, p = 0.88) in controls. In case-control analyses, alloimmunisation relative risks among DAT-positive patients increased to 1.7 (CI 1.1-2.8). Additional adjustments for pre-DAT transfusion exposure or the extent of Rh/K mismatching did not impact results. In conclusion, while patients with DAT positivity show an intrinsically increased alloimmune red blood cell response, their absolute risk is comparable to control patients due to counteracting co-existing immunosuppressive conditions. Consequently, isolated DAT positivity in patients lacking overt haemolysis or complicated alloantibody testing does not seem to warrant extended matching strategies., (© 2024 The Authors. British Journal of Haematology published by British Society for Haematology and John Wiley & Sons Ltd.)

Published
2024
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48. Donor pregnancies and transfusion recipient mortality: A role for red blood cell storage?

Author

Valk SJ, Caram-Deelder C, Evers D, de Vooght KMK, van de Kerkhof D, Wondergem MJ, Péquériaux NCV, Hudig F, Zwaginga JJ, de Korte D, van de Watering LMG, Middelburg RA, and van der Bom JG

Subjects
Adult, Pregnancy, Humans, Male, Female, Cohort Studies, Proportional Hazards Models, Blood Donors, Blood Preservation adverse effects, Erythrocyte Transfusion adverse effects, Erythrocytes
Abstract

Background and Objectives: Donor characteristics have been implicated in transfusion-related adverse events. Uncertainty remains about whether sex, and specifically pregnancy history of the blood donor, could affect patient outcomes. Whether storage duration of the blood product could be important for patient outcomes has also been investigated, and a small detrimental effect of fresh products remains a possibility. Here, we hypothesize that fresh red blood cell products donated by ever-pregnant donors are associated with mortality in male patients., Materials and Methods: We used data from a cohort study of adult patients receiving a first transfusion between 2005 and 2015 in the Netherlands. The risk of death after receiving a transfusion from one of five exposure categories (female never-pregnant stored ≤10 days, female never-pregnant stored >10 days, female ever-pregnant stored ≤10 days, female ever-pregnant stored >10 days and male stored for ≤10 days), compared to receiving a unit donated by a male donor, which was stored for >10 days (reference), was calculated using a Cox proportional hazards model., Results: The study included 42,456 patients who contributed 88,538 person-years in total, of whom 13,948 died during the follow-up of the study (33%). Fresh units (stored for ≤10 days) from ever-pregnant donors were associated with mortality in male patients, but the association was not statistically significant (hazard ratio 1.39, 95% confidence interval 0.97-1.99). Sensitivity analyses did not corroborate this finding., Conclusion: These findings do not consistently support the notion that the observed association between ever-pregnant donor units and mortality is mediated by blood product storage., (© 2023 The Authors. Vox Sanguinis published by John Wiley & Sons Ltd on behalf of International Society of Blood Transfusion.)

Published
2024
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49. Routine Lupus Anticoagulant Sensitive aPTT Testing Can Prevent Unnecessary LA Testing.

Author

Smit B, Hudig F, Venhuizen JH, Haitjema S, Limper M, Urbanus R, and Huisman A

Subjects
Humans, Partial Thromboplastin Time, Blood Coagulation Tests, Reference Values, Lupus Coagulation Inhibitor, Antiphospholipid Syndrome
Abstract

Even though routine screening of the general hospital population is discouraged, medical laboratories may use a "lupus sensitive" activated partial thromboplastin time test (aPTT) with phospholipid concentrations that are susceptible to inhibition by lupus anticoagulant (LA), to screen for the presence of LA. If deemed necessary, follow-up testing according to ISTH guidelines may be performed. However, LA testing is a laborious and time-consuming effort that is often not readily available due to a lack of automation and/or temporary unavailability of experienced staff. In contrast, the aPTT is a fully automated test that is available 24/7 in almost all medical laboratories and is easily interpreted with the use of reference ranges. In addition to clinical signs, the result of an LA sensitive aPTT may thus be used to lower the suspicion of the presence of LA and reduce costly follow-up testing. In this study, we show that a normal LA sensitive aPTT result may be safely used to refrain from LA testing in the absence of strong clinical suspicion.

Published
2023
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