Search

This study sought to determine the level of effectiveness of the Philippine National Police (PNP) front liners in preventing the spread of COVID-19 in Tagbilaran City, Bohol from the perspective of both the PNP officers and the residents of Tagbilaran City. This study utilized a quantitative method and survey technique to describe the level of effectiveness of the PNP front liners in gathering data. Three hundred (300) randomly selected residents from random households in Tagbilaran City and thirty (30) PNP Front liners were made participants in the study. On the effectiveness in enforcing the preventive measures against COVID-19 in the City of Tagbilaran, it was rated as strongly effective by both the PNP officers and the residents. Data revealed a significant relationship between the profile of the two groups of respondents on the level of effectiveness in the enforcement of preventive measures. In conclusion, the PNP front liners have demonstrated their adequacy in carrying out their obligation, execution of public health safety protocols, and appropriate application of laws towards keeping the community safe from the fatal impact of COVID-19, and most of the respondents were on the same line of thinking of the execution as to rules in response to control the spread in their locality. It is recommended that the PNP continue the strict implementation of its policies and guidelines in response to the COVID-19 pandemic.

Background There is limited data available on the safety of therapeutic plasma exchange (TPE) for paediatric neuro-immunological disorders (PNID). In this study, we report our data on safety and feasibility of TPE for these disorders. Methods Retrospective chart review was performed to include all patient who received TPE for four major PNID conditions: autoimmune encephalitis (AIE), acute disseminated encephalomyelitis (ADEM), Neuromyelitis optic spectrum disorder (NMOSD) and transverse myelitis (TM). We recorded minor and major adverse effects (AEs) associated with each TPE procedure. Secondary analysis also looked at the efficacy data of TPE on these patients. Results Thirty-two patients with PNID received a total of 186 TPE cycles. Out of these, only 1 cycle (0.89%) in AIE subgroup, 1 (4.3%) in NMOSD and 1 (4.5%) in TM had adverse effects. No patients had major side effects. Conclusion TPE was safe and well tolerated in our PNID patients.

Background The Spectra Optia allows automated performance of red blood cell reduction and isovolemic hemodilution (IHD) prior to standard red cell exchange (RCE), and is primarily intended for patients with sickle cell disease (SCD) undergoing chronic RCE. Data on the safety of inducing transient further anemia and the benefits of IHD-RCE is limited and occasionally contradictory. Study design and methods In this retrospective crossover analysis of six patients with SCD who underwent chronic exchange with standard RCE (Cobe Spectra) followed by IHD-RCE (Spectra Optia), we compared safety and benefit outcomes with IHD-RCE vs standard RCE. Results There were statistically but not clinically significant drops in blood pressure in the post-IHD phase. With IHD-RCE, there were significant reductions in red blood cell (RBC) usage and/or lower fraction of cells and significant increases in postprocedure hematocrit (Hct) associated with increased preprocedure Hct. There were no differences achieved in the time interval between procedures or in the net RBC gain with IHD-RCE. Overall, there were also no significant differences in pre- and postprocedure percentage of hemoglobin S, reticulocyte count, interval daily hemoglobin A decrement, or postprocedure white blood cell, neutrophil, or platelet counts. Conclusions Our study supports that IHD-RCE can be safely used in patients with stroke risk and compared to standard RCE, results in benefits of lower RBC usage and/or fraction of cells remaining and higher postprocedure Hct associated with higher preprocedure Hct. These findings support wider use of IHD-RCE, especially in the current environment with reduced availability of minority units.

BACKGROUND Depletion of haptoglobin (Hp) and hemopexin (Hx) with increase in free hemoglobin and heme are important etiologies of vaso-occlusive complications in sickle cell disease (SCD). This study is the first to show an association between clinical improvement in SCD and repletion of Hp and Hx by therapeutic plasma exchange (TPE) using plasma replacement. STUDY DESIGN AND METHODS Thirteen fresh-frozen plasma (FFP) units derived from consecutive whole blood donations were thawed at 37°C after 10 months of storage; Hp and Hx concentrations immediately postthaw and after 5 days of refrigerated storage were analyzed by enzyme-linked immunosorbent assay (ELISA). All SCD patients presenting to a single institution over a 2-year period with acute multiorgan failure syndrome resistant to red blood cell exchange (RCE) were treated with TPE with FFP replacement; concentrations of Hp, Hx, and heme were evaluated before and after TPE by ELISA. RESULTS Plasma concentrations of Hp and Hx decreased approximately 20% (p ≤ 0.002) after 5 days of refrigerated storage. Significant mean fold increases after TPE of 10 for Hp (p

Introduction/Objective H antigen is a precursor for A and B antigens and is mostly converted except for the O blood group, which has the highest amount of H antigen. I is present on all adult RBCs. Anti-IH is usually an IgM antibody active at cold temperatures, and rarely demonstrates a wide thermal amplitude and can cause a significant hemolytic transfusion reaction. Methods Data was collected from patient information and transfusion management systems. Results 38 year old female with sickle cell disease presented to the emergency room with dizziness, tachypnea and Hgb: 5.9 g/dl Hct:19.1%. Upon further review, patient chart showed that she had received an emergency RBC exchange transfusion 21 days prior to this admission for acute chest syndrome. She was B positive. The units for RBC exchange consisted of 5 group B and 1 group O units and an additional 1 group O unit later. All RBC units were matched for her phenotype; Rh, K, Duffy & Kidd, except anti-S which was ruled out. At the time of discharge, Hgb was 9.3 g/dl and Hct was 27.7%. The drop in Hgb between discharge and the present admission prompted a suspicion for delayed hemolytic reaction/hyperhemolysis. The sample sent to the local Reference Laboratory came back as follows: DAT/Coombs Positive, DAT C3 positive; positive for cold auto-anti-IH antibody. A thermal amplitude test indicated that the anti-IH was reactive at 30 C and therefore had the potential to be of clinical significance. Her Hgb continued to drop and 3 days later Hb=3.7 g/dl with instructions not to transfuse unless clinically emergent. With treatment of IVIG and steroids, reducing further blood draws and monitoring the patient for clinical symptoms only, her Hgb/Hct started to rise and the patient was discharged 4 days later with Hgb: 6.4 g/dl, and no symptoms of anemia. Conclusion Our case study is important in two ways: Firstly, it raises awareness of the severity of a cold autoantibody, i.e. anti-IH, with a wide thermal amplitude. Specifically, in this case, our attempt to provide phenotypically similar RBCs resulted in the destruction of all the type O donor cells as well as some of the B donor cells. Secondly, even with Hgb counts as low as 3.7, treating the patient and not the number proved to be better clinical practice. In conclusion, a good monitoring protocol for sickle cell patients is required to transfuse less and avoid serious complications.

The intracellular parasites Babesia microti and Babesia duncani can be transmitted by blood transfusion and cause severe life-threatening hemolytic anemia in high-risk patients, including those with sickle cell disease. The rarity of the diagnosis, as well as its similar clinical presentation to delayed hemolytic transfusion reaction, may lead to a delay in diagnosis, as well as inappropriate treatment with steroids or other immunosuppressive agents. The morbidity caused by this disease in especially vulnerable populations justifies the need for a universal blood-screening program in endemic areas.

Background: Isovolemic hemodilution (IHD-RCE), an add-on to standard red cell exchange (RCE), was recently FDA-approved on select apheresis devices. Equipoise exists as to the degree of red cell unit reduction and time interval extension between procedures with IHD-RCE. Also, concern has been raised that the transient hematocrit (Hct) decrease and potential hypotension with IHD-RCE causes ischemic brain injury, especially with Moya Moya disease. Again, there is equipoise, with only one of 4 studies reporting increased hypotension and no studies of ischemic brain injury with IHD-RCE. We therefore conducted a retrospective crossover study of efficacy and safety of IHD-RCE in our sickle cell disease patients, three of whom had Moya Moya, and report follow-up brain MRI/MRA data, heretofore not reported in the literature. Study design: This was a retrospective review of patients who crossed over from standard RCE (Cobe Spectra) to IHD-RCE (Spectra Optia). The IHD phase used normal saline for replacement fluid. Minimum (post-IHD) hematocrits (Hcts) and post-procedure Hcts were based upon pre-procedure Hcts as per Matevosyan et al, JCA 2012. Pre-procedure CBCs, reticulocyte counts, and serum ferritins were drawn within 72 hours of the procedure and post-procedure CBCs drawn immediately post-procedure. All red cell units were leuko-reduced, CEK matched, and less than 15 days old when possible. Methods: The same number of procedures were analyzed for standard RCE and IHD-RCE, with the RCE procedures most recent to crossover to IHD-RCE used for comparison. Means of continuous variables were calculated for each patient; means and standard deviations of the patient means are shown, unless otherwise indicated. Paired t-testing was used to compare IHD-RCE to RCE († in tables indicates p-value < 0.05) Results: Patients: All 6 patients (3 M, 3 F) were black; 5 had HbSS and 1 had SB+thal. The indication for RCE was stroke prophylaxis in four, 3 of whom had Moya-Moya disease, and frequent vaso-occlusive crisis (VOC) in two. Mean patient age at the time of first IHD-RCE was 15 ± 2 years, and a mean 26 ± 12 procedures of each procedure type was analyzed for IHD-RCE to RCE comparisons. Patient total blood volume (TBV) significantly increased from the RCE to IHD-RCE periods and was accounted for in the analysis. Procedure-centric measures (Table 1). Despite increasing TBV, red cell unit usage did not increase, and the volume of donor red cells transfused per mL TBV significantly decreased with IHD-RCE. There was no increase in inter-procedural interval. Patient-centric efficacy measures (Table 2): Despite the decreased volume of donor red cells transfused per mL TBV, and similar post- and pre-procedure HbS %s between IHD-RCE and RCE, the pre-procedure Hct was slightly (5%) increased with IHD-RCE. Procedural safety-related measures (Table 3): Although there were statistically significant drops in systolic and diastolic blood pressures (BP) post-IHD compared to pre-procedure BP, the degrees (about -6%) were mild. By procedure end, there were no overall significant differences in BP from pre-procedure BP. In addition, there was no overall significant change in heart rate post-IHD or post-procedure. Actual patient adverse events (Table 4): One patient had a single possibly IHD-related Grade 2 symptomatic (dizziness) vasovagal event, occurring at procedure end and resolved with normal saline bolus. All 4 patients on IHD-RCE for stroke prophylaxis had follow-up MRI/MRA after switching to IHD-RCE. One patient showed new silent strokes and vasculopathy but her prior MRI/MRA predated her standard RCE period. One patient who had progressed on standard RCE had no progression on IHD-RCE. The other two patients had stable MRI/MRA. Conclusion: When reducing pre-procedure Hct by 20-24% during the IHD phase, our data confirm the 11-13% reduction in red cell unit usage with IHD-RCE reported by Sarode et al, JCA 2011 and Hequet et al, Transfusion 2019, but do not support an increased inter-procedural interval of 16 days as per Sarode et al. Most patients had a mild (< 15%) and asymptomatic drop in systolic and diastolic BPs with IHD-RCE; a minority also had a very mild ( Disclosures No relevant conflicts of interest to declare.

Opsoclonus myoclonus ataxia syndrome (OMAS) can be refractory to standard therapies and devastating. Alternative treatments are imperative. A 14-month-old male diagnosed with neuroblastoma and paraneoplastic OMAS achieved complete cancer remission with chemotherapy. The OMAS, however, persisted over the subsequent 4 years despite numerous immune-modulatory and immunosuppressive therapies. The patient ultimately achieved complete remission following therapeutic plasma exchange (TPE) combined with rituximab and intravenous immunoglobulin. After three asymptomatic years, he relapsed. Upon reintroducing TPE and rituximab plus oral prednisolone, the patient rapidly achieved a second complete remission. This case offers proof-of-principle for the potential efficacy of TPE for neuroblastoma-associated OMAS.

Objectives: Team-based learning (TBL) has been integrated into undergraduate and medical education curricula in many institutions. However, TBL has not been widely introduced into postgraduate medical education. Our study aimed to measure the effect of TBL on promoting learning and teamwork in the setting of pathology residency training. Methods: Four TBL sessions were held and individual and group readiness assurance tests (IRAT/GRATs) were performed; scores were compared using Wilcoxon matched-pairs signed rank tests. Residents completed 18-item validated team performance surveys measuring the quality of team interactions on a scale of 0 (none of the time) to 6 (all of the time). Mean and standard deviation were calculated for each item. Results: Scores on the IRAT vs GRAT were significantly different ( P < .05). The team performance survey received mean scores ranging from 5.3 ± 1.1 to 6.0 ± 0.0. Conclusions: The use of TBL promotes teamwork and learning in a pathology residency program. Residents scored higher on the readiness assurance tests when working in teams, demonstrating the effectiveness of team learning and achievement. In addition, the Accreditation Council for Graduate Medical Education competencies of professionalism and interpersonal and communication skills were further enhanced by incorporating TBL into pathology residency training.

Extracorporeal removal or modulation of circulating immune complexes (CIC) from plasma of animals and humans with malignant disease may be associated with induction of immune-mediated anti-tumor responses. Immunoadsorption columns containing heat-killed and formalin-fixed Staphylococcus aureus or staphylococcal protein A have been used for this purpose but treatments have often been associated with cardiopulmonary toxicity. Recently, an immunoadsorption device containing highly purified protein A covalently attached to a silica matrix (PROSORBA column) was used to treat 142 patients with refractory malignancies and 22 of 104 patients evaluated for anti-tumor response had objectively measurable reduction in tumor burden. In contrast to earlier experience with other devices, the procedures used in this trial were well tolerated and could be performed on an outpatient basis. The most common side effects observed among 1,306 treatments were chills (28% of treatments), low grade fever (28%), and musculoskeletal pain (16%). Side effects were mild to moderate and required no treatment or only symptomatic treatment. Treatment schedules were interrupted due to side effects for only six patients and there were no treatment-related deaths. Of 64 patients available for long-term follow-up evaluation (mean of 11 months), none exhibited evidence of long-term treatment-related side effects. None of the patient deaths in that period were associated with short or long-term treatment-related side effects. Protein A-silica (PROSORBA columns) can be used safely for development of further experimental treatments of malignant disease.

Abstract 272 The treatment of Thrombotic Thrombocytopenic Purpura (TTP) with therapeutic plasma exchange (TPE) with Fresh Frozen Plasma (FFP) and/or Cryopoor Plasma (CPP) replacement is well established. This process adds plasma ADAMTS-13 activity and removes plasma ADAMTS-13 inhibitor. Limited data has indicated combination of 5% albumin in the first half of the procedure followed by FFP in the second half of the procedure is effective in treating TTP. Theoretical calculation of addition of exogenous ADAMTS-13 is still substantial because ADAMTS-13 infused initially is removed as the plasma exchange procedure progresses. A 50% reduction of FFP would decrease the number of donor exposures and transfusion reactions associated with human plasma. Further, plasma of limited supply, such as AB plasma, can be more effectively used. We report a retrospective comparison of TPE for TTP using all FFP versus 5% Albumin/FFP (AFFP) replacement fluid. One health system with two closely connected tertiary campuses with common Hematology/Oncology services and Transfusion Medicine services treated 17 idiopathic TTP patients (March/2009 – June/2012) with documented very low ADAMTS-13 levels ( Table 1 shows that the FFP versus the AFFP groups at presentations are comparable. Table 2 indicated FFP versus AFFP treatment is comparable. For the FFP and AFFP groups respectively, mean number of total procedures: 16 vs. 14, length of time from first TPE to last TPE 19 vs. 22 days, Relapses 2 vs. 2, and deaths 1 vs. 0. Conclusion: The use of AFFP as replacement fluid for idiopathic TTP does not appear to be inferior to 100% FFP replacement. Length of treatment, rate of recovery, and relapse rate are comparable. There were more deaths in the FFP cohort but the low number of observations limits the significance. AFFP fluid replacement should be considered for TPE in idiopathic TTP. Disclosures: No relevant conflicts of interest to declare.

The goal of the present study was to study the quantity and function of regulatory and suppressor T cells, and the effect of sex hormones on T reg functions in healthy individuals and in SLE patients of both genders. Immunophenotyping of PBMC from SLE patients (n =27) indicated significantly reduced numbers of CD4+CD25hi Foxp3+ T cells (p An Inhibitor of bestradiol (ERa) increased apoptosis in male SLE patients only. These data suggest that estrogen affect the T regulatory compartment in healthy females and and further decreases Foxp3 mRNA in SLE patients of both genders.

We investigate experimentally the idea of exchange degeneracy of vector- and tensor-meson Regge trajectories for several pairs of reactions related by s ↔ u crossing.

Mononuclear leukocytes (MNL) were isolated from human blood by Ficoll-Hypaque. These cells were further separated into lymphocyte (L) and monocyte (M) enriched fractions. L contained 99% lymphocytes and M contained 74% monocytes, a threefold enrichment over MNL. Specific binding of somatostatin, glucagon, and insulin was measured in the three fractions. Binding of all three hormones in the M fraction was increased by a factor of 3 compared with MNL and was linear with cell number. Binding of glucagon and insulin to the L fraction was very low while, in contrast, somatostatin binding was substantial and linear with lymphocyte number. Autoradiography confirmed the binding of glucagon to monocytes and of somatostatin to both monocytes and lymphocytes. Somatostatin is the first of the peptide hormones shown to bind to both types of circulating mononuclear cells, perhaps complicating quantification of somatostatin binding in disease states in which differential alteration of binding to lymphocytes or monocytes might occur.