94 results on '"Savoia, H."'
Search Results
2. Clinical care of pregnant and postpartum women with COVID-19: Living recommendations from the National COVID-19 Clinical Evidence Taskforce.
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Burgess P., Morphet J., Nou S., Russo P., Sarson M., Young A., Norris S., Morris-Donovan B., Gurry S., Hudson E., Hurley S., Primmer D., Timms S., Whicker S., Mukherjee S., Booth K., Cameron P., Cooper M., Cheng A., Fowler P., Frydenberg M., McGloughlin S., McPhee E., Mitchell B., O'Donnell C., Parr M., Phillips J., Varndell W., Whyte I., Randall R., Brightwell R., Condon L., Deshpande A., Ehm A., Ferrie M., Muller J., Pullin L., Robinson E., Witt A., Larkins S., Morgan M., Taylor G., Agostino J., Douglas K., Ewald B., Fornasier D., Knight S., Nelson C., Peachey L., Peiris D., Driel M., Walters L., Weaver I., Burr L., Hendel S., Shekar K., Avard B., Cairns K., Glanville A., Gilroy N., Myles P., O'Sullivan R., Robinson O., Sharland C., McCarthy S., Wark P., McGoughlin S., Hodgson C., Ankravs M., Hansen K., Huckson S., Iredell J., Janerka C., Jaspers R., Litton E., Macdonald S., Peake S., Bowen A., McMullan B., Tingay D., Vasilunas N., Anderson L., Best J., Burns P., Erickson S., Fancourt N., Goff Z., Kapuya V., Keyte C., Malyon L., Wurzel D., Agar M., Lindley R., Smallwood N., Callary M., Chapman M., Good P., Jenkin P., Morgan D., Naganathan V., Srikanth V., Tuffin P., Whiting E., William L., Yates P., Barber B., Davies J., Davis J., Gwee A., Leder K., Matthews G., McMahon J., Peel T., Raftery C., Rees M., Roberts J., Seppelt I., Wibrow B., Baker R., Curnow J., Cutts B., Enjeti A., Forbes A., Ho P., Holyoak A., Liley H., McFadyen J., McQuilten Z., Merriman E., Savoia H., Tan C.W., Tran H., Ward C., Williams K., Ballard N., Bendall S., Bhanderi N., Byers L., Craig S., Ellis D., Ewald D., Fairley C., Hoggard B., Cong M.L., Morley P., Nair P., Pearce A., Turner T., Callesen H., Campbell S., Ring J., Wilson A., Henry D., Pearson S., Boyle D., Chidwick K., Chapman W., French C., Pearce C., Snelling T., Bero L., Grundy Q., Lexchin J., Mintzes B., Vogel J.P., Tendal B., Giles M., Whitehead C., Burton W., Chakraborty S., Cheyne S., Downton T., Fraile Navarro D., Gleeson G., Gordon A., Hunt J., Kitschke J., McDonald S., McDonnell N., Middleton P., Millard T., Murano M., Oats J., Tate R., White H., Elliott J., Roach V., Homer C.S.E., McGowan S., Ballenden N., Barrett T.-L., Beavis V., Saunders J.B., Buchanan T., Buchanan-Grey M., Casey D., Cowie M., Doyle J., Gnjidic D., Green S., Greenland R., Griffin K., Groombridge S., Hardy L., Hodak A., Holley A., Jovanovska V., Michaels K., Burgess P., Morphet J., Nou S., Russo P., Sarson M., Young A., Norris S., Morris-Donovan B., Gurry S., Hudson E., Hurley S., Primmer D., Timms S., Whicker S., Mukherjee S., Booth K., Cameron P., Cooper M., Cheng A., Fowler P., Frydenberg M., McGloughlin S., McPhee E., Mitchell B., O'Donnell C., Parr M., Phillips J., Varndell W., Whyte I., Randall R., Brightwell R., Condon L., Deshpande A., Ehm A., Ferrie M., Muller J., Pullin L., Robinson E., Witt A., Larkins S., Morgan M., Taylor G., Agostino J., Douglas K., Ewald B., Fornasier D., Knight S., Nelson C., Peachey L., Peiris D., Driel M., Walters L., Weaver I., Burr L., Hendel S., Shekar K., Avard B., Cairns K., Glanville A., Gilroy N., Myles P., O'Sullivan R., Robinson O., Sharland C., McCarthy S., Wark P., McGoughlin S., Hodgson C., Ankravs M., Hansen K., Huckson S., Iredell J., Janerka C., Jaspers R., Litton E., Macdonald S., Peake S., Bowen A., McMullan B., Tingay D., Vasilunas N., Anderson L., Best J., Burns P., Erickson S., Fancourt N., Goff Z., Kapuya V., Keyte C., Malyon L., Wurzel D., Agar M., Lindley R., Smallwood N., Callary M., Chapman M., Good P., Jenkin P., Morgan D., Naganathan V., Srikanth V., Tuffin P., Whiting E., William L., Yates P., Barber B., Davies J., Davis J., Gwee A., Leder K., Matthews G., McMahon J., Peel T., Raftery C., Rees M., Roberts J., Seppelt I., Wibrow B., Baker R., Curnow J., Cutts B., Enjeti A., Forbes A., Ho P., Holyoak A., Liley H., McFadyen J., McQuilten Z., Merriman E., Savoia H., Tan C.W., Tran H., Ward C., Williams K., Ballard N., Bendall S., Bhanderi N., Byers L., Craig S., Ellis D., Ewald D., Fairley C., Hoggard B., Cong M.L., Morley P., Nair P., Pearce A., Turner T., Callesen H., Campbell S., Ring J., Wilson A., Henry D., Pearson S., Boyle D., Chidwick K., Chapman W., French C., Pearce C., Snelling T., Bero L., Grundy Q., Lexchin J., Mintzes B., Vogel J.P., Tendal B., Giles M., Whitehead C., Burton W., Chakraborty S., Cheyne S., Downton T., Fraile Navarro D., Gleeson G., Gordon A., Hunt J., Kitschke J., McDonald S., McDonnell N., Middleton P., Millard T., Murano M., Oats J., Tate R., White H., Elliott J., Roach V., Homer C.S.E., McGowan S., Ballenden N., Barrett T.-L., Beavis V., Saunders J.B., Buchanan T., Buchanan-Grey M., Casey D., Cowie M., Doyle J., Gnjidic D., Green S., Greenland R., Griffin K., Groombridge S., Hardy L., Hodak A., Holley A., Jovanovska V., and Michaels K.
- Abstract
To date, 18 living recommendations for the clinical care of pregnant and postpartum women with COVID-19 have been issued by the National COVID-19 Clinical Evidence Taskforce. This includes recommendations on mode of birth, delayed umbilical cord clamping, skin-to-skin contact, breastfeeding, rooming-in, antenatal corticosteroids, angiotensin-converting enzyme inhibitors, disease-modifying treatments (including dexamethasone, remdesivir and hydroxychloroquine), venous thromboembolism prophylaxis and advanced respiratory support interventions (prone positioning and extracorporeal membrane oxygenation). Through continuous evidence surveillance, these living recommendations are updated in near real-time to ensure clinicians in Australia have reliable, evidence-based guidelines for clinical decision-making. Please visit https://covid19evidence.net.au/ for the latest recommendation updates.Copyright © 2020 The Authors. Australian and New Zealand Journal of Obstetrics and Gynaecology published by John Wiley & Sons Australia, Ltd on behalf of Royal Australian and New Zealand College of Obstetricians and Gynaecologists
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- 2021
3. Changes in emergency department blood product use for major paediatric trauma following the implementation of a major haemorrhage protocol
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Long, E, Williams, A, Babl, FE, Kinmonth, A, Tse, WC, Palmer, CS, Crighton, G, Savoia, H, Teague, WJ, Nystrup, KB, Long, E, Williams, A, Babl, FE, Kinmonth, A, Tse, WC, Palmer, CS, Crighton, G, Savoia, H, Teague, WJ, and Nystrup, KB
- Abstract
OBJECTIVE: Fixed ratio blood product administration may improve outcomes in trauma patients with massive blood loss. The present study aimed to describe the impact of a major haemorrhage protocol (MHP) on the ratio of blood products administered for paediatric major trauma. METHODS: Retrospective observational study in a state-designated paediatric major trauma centre in Melbourne, Australia. Children with major trauma who received blood products in the ED were identified from a hospital trauma registry. Blood product ratios before, during and after implementation of a hospital MHP were compared in consecutive 2 year blocks. RESULTS: Over a 6 year period, 767 major trauma patients were identified, of whom 47 received blood products in the ED and were included in the analysis; 14 pre-MHP implementation, 24 during-MHP implementation and nine post-MHP implementation. No patients received blood products at a ratio of 1:1:1 for red blood cells:fresh frozen plasma:platelets, respectively, during any time period. In this cohort of predominantly blunt trauma, blood products were infrequently administered in the ED because of the low prevalence of massive blood loss. Coagulopathy and hypofibrinogenaemia were commonly observed, nearly half of included patients were managed operatively and one quarter did not survive their injuries. CONCLUSION: The implementation of a MHP did not change the ratio of blood product administration in this cohort of patients because of the infrequency of massive blood loss. Future studies may focus on the impact of treating coagulopathy and hypofibrinogenaemia on patient-centred outcomes.
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- 2021
4. Severe fetal ischaemic brain injury caused by homozygous protein C deficiency
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Stutterd, C., Savoia, H., Fink, A. M., and Stark, Z.
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- 2014
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5. Safety and efficacy outcomes of home and hospital warfarin management within a paediatric anticoagulation clinic: PB 3.68–2
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Jones, S, McLoughlin, S, Piovesan, D, Savoia, H, and Monagle, P
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- 2013
6. ABSTRACT NO.: 35: Management of foetomaternal/neonatal alloimmune thrombocytopenia (NAIT): an evaluation of current Australian practice
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McQuilten, Z., Cole, S., Davies, M., Holdsworth, R., Savoia, H., Saxon, B., Williams, B., Wood, E., and Phillips, L.
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- 2012
7. PREDICTORS OF EMERGENCY AND MASSIVE TRANSFUSIONS IN PAEDIATRIC TRAUMA: 151
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Trottier, E. D., Bevan, C. A., Palmer, C. S., and Savoia, H.
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- 2012
8. How human factors contribute to ‘wrong blood in tube’ (WBIT) events in emergency departments
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Jeffcott, S, Cameron, P, Phillips, Steele L, Polizzotto, M, McQuilten, Z, Magrin, G, Cole-Sinclair, M, Savoia, H, and Wood, E
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- 2011
9. Neonatal transfusions
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New, H. V., Stanworth, S. J., Engelfriet, C. P., Reesink, H. W., McQuilten, Z. K., Savoia, H. F., Wood, E. M., Olyntho, S., Trigo, F., Wendel, S., Lin, Y., Hume, H., Petäjä, J., Krusius, T., Villa, S., Ghirardello, S., von Lindern, J., Brand, A., Hendrickson, J. E., Josephson, C. D., Strauss, R. G., Luban, N. L. C., and Paul, W.
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- 2009
10. Postnatal intervention for the treatment of FNAIT: a systematic review
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Baker, J.M., Shehata, N., Bussel, J., Murphy, M.F., Greinacher, A., Bakchoul, T., Massey, E., Lieberman, L., Landry, D., Tanael, S., Arnold, D.M., Baidya, S., Bertrand, G., Kjaer, M., Kaplan, C., Kjeldsen-Kragh, J., Oepkes, D., Savoia, H., Ryan, G., Hume, H., Allard, S., Bianco, C., Callum, J., Compernolle, V., Fergusson, D., Fung, M., Nahirniak, S., Pavenski, K., Pink, J., Ponnampalam, A., Rebulla, P., So-Osman, C., Stanworth, S.J., Szczepiorkowski, Z.M., Tinmouth, A.T., Wood, E., and ICTMG
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medicine.medical_specialty ,Adrenal cortex hormones ,Platelet Transfusion ,03 medical and health sciences ,0302 clinical medicine ,Adrenal Cortex Hormones ,030225 pediatrics ,Internal medicine ,Humans ,Medicine ,Platelet ,030212 general & internal medicine ,Fetus ,Hematology ,biology ,Platelet Count ,business.industry ,Infant, Newborn ,Recem nascido ,Immunoglobulins, Intravenous ,Obstetrics and Gynecology ,medicine.disease ,Combined Modality Therapy ,Human platelet antigen ,Thrombocytopenia, Neonatal Alloimmune ,Fetal Diseases ,Platelet transfusion ,Anesthesia ,Pediatrics, Perinatology and Child Health ,Neonatal alloimmune thrombocytopenia ,biology.protein ,business ,Intracranial Hemorrhages - Abstract
Objective: Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is associated with life-threatening bleeding. This systematic review of postnatal management of FNAIT examined transfusion of human platelet antigen (HPA) selected or unselected platelets, and/or IVIg on platelet increments, hemorrhage and mortality. Study design: MEDLINE, EMBASE and Cochrane searches were conducted until 11 May 2018. Result: Of 754 neonates, 382 received platelet transfusions (51%). HPA-selected platelets resulted in higher platelet increments and longer response times than HPA-unselected platelets. However, unselected platelets generally led to sufficient platelet increments to 30 × 10 9 /L, a level above which intracranial hemorrhage or other life-threatening bleeding rarely occurred. Platelet increments were not improved with the addition of IVIg to platelet transfusion. Conclusion: Overall, HPA-selected platelet transfusions were more effective than HPA-unselected platelets but unselected platelets were often effective enough to achieve clinical goals. Available studies do not clearly demonstrate a benefit for addition of IVIg to platelet transfusion.
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- 2019
11. Maternal HPA-1a antibody level and its role in predicting the severity of Fetal/Neonatal Alloimmune Thrombocytopenia: a systematic review
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Kjaer, M., Bertrand, G., Bakchoul, T., Massey, E., Baker, J.M., Lieberman, L., Tanael, S., Greinacher, A., Murphy, M.F., Arnold, D.M., Baidya, S., Bussel, J., Hume, H., Kaplan, C., Oepkes, D., Ryan, G., Savoia, H., Shehata, N., Kjeldsen-Kragh, J., Allard, S., Bianco, C., Callum, J., Compernolle, V., Fergusson, D., Fung, M., Nahirniak, S., Pavenski, K., Pink, J., So-Osman, C., Stanworth, S.J., Szczepiorkowski, Z.M., Wood, E., and Int Collaboration Transfusion Med
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medicine.medical_specialty ,medicine.drug_class ,Antibody level ,030204 cardiovascular system & hematology ,Monoclonal antibody ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Humans ,Medicine ,Antigens, Human Platelet ,Prospective cohort study ,platelet ,Fetus ,Antibody measurement ,biology ,Platelet Count ,business.industry ,Obstetrics ,monoclonal antibody immobilization of platelet antigen ,maternal HPA-1a antibodies ,Infant, Newborn ,Integrin beta3 ,Retrospective cohort study ,Hematology ,General Medicine ,medicine.disease ,bleeding ,Thrombocytopenia, Neonatal Alloimmune ,Neonatal alloimmune thrombocytopenia ,biology.protein ,Female ,alloimmune thrombocytopenia ,Antibody ,business ,Biomarkers ,Maternal Serum Screening Tests ,030215 immunology - Abstract
Background and Objectives: In Caucasians, fetal/neonatal alloimmune thrombocytopenia (FNAIT) is most commonly due to maternal HPA-1a antibodies. HPA-1a typing followed by screening for anti-HPA-1a antibodies in HPA-1bb women may identify first pregnancies at risk. Our goal was to review results from previous published studies to examine whether the maternal antibody level to HPA-1a could be used to identify high-risk pregnancies. Materials and Methods: The studies included were categorized by recruitment strategies: screening of unselected pregnancies or samples analyzed from known or suspected FNAIT patients. Results: Three prospective studies reported results from screening programmes, and 10 retrospective studies focused on suspected cases of FNAIT. In 8 studies samples for antibody measurement, performed by the monoclonal antibody immobilization of platelet antigen (MAIPA) assay, and samples for determining fetal/neonatal platelet count were collected simultaneously. In these 8 studies, the maternal antibody level correlated with the risk of severe thrombocytopenia. The prospective studies reported high negative predictive values (88–95%), which would allow for the use of maternal anti-HPA-1a antibody level as a predictive tool in a screening setting, in order to identify cases at low risk for FNAIT. However, due to low positive predictive values reported in prospective as well as retrospective studies (54–97%), the maternal antibody level is less suited for the final diagnosis and for guiding antenatal treatment. Conclusion: HPA-1a antibody level has the potential to predict the severity of FNAIT. (Less)
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- 2019
12. Vox Sanguinis International Forum on paediatric indications for blood component transfusion
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Bruun, M.T., Yazer, M.H., Spinella, P.C., Titlestad, K., Lozano, M., Delaney, M., Lejdarova, H., Pavlova, D., Trakhtman, P., Starostin, N., Zhiburt, E., van Kraaij, M.G.J., Huisman, A. (Annemiek), Kutner, J.M., Sakashita, A.M., Yokoyama, A.P.H., Zubicaray, J., Sevilla, J., Okazaki, H., Hiwatari, M., Nagura, Y., Manzini, P.M., Facco, G., Pecoraro, C., Singh, L. (Lalji), Hans, R., Sharma, R.R., Kumar, P., Wikman, A., Deschmann, E., Kaur, H., Lam, J.C.M., Ho, S.K.Y., Koh, P.L., Moss, R., New, H.V., Kinmonth, A., Comande, M., Savoia, H., Crighton, G., Yacobovich, J., Yahalom, V., Lau, W. (Wim) de, Bruun, M.T., Yazer, M.H., Spinella, P.C., Titlestad, K., Lozano, M., Delaney, M., Lejdarova, H., Pavlova, D., Trakhtman, P., Starostin, N., Zhiburt, E., van Kraaij, M.G.J., Huisman, A. (Annemiek), Kutner, J.M., Sakashita, A.M., Yokoyama, A.P.H., Zubicaray, J., Sevilla, J., Okazaki, H., Hiwatari, M., Nagura, Y., Manzini, P.M., Facco, G., Pecoraro, C., Singh, L. (Lalji), Hans, R., Sharma, R.R., Kumar, P., Wikman, A., Deschmann, E., Kaur, H., Lam, J.C.M., Ho, S.K.Y., Koh, P.L., Moss, R., New, H.V., Kinmonth, A., Comande, M., Savoia, H., Crighton, G., Yacobovich, J., Yahalom, V., and Lau, W. (Wim) de
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- 2019
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13. Fetal and neonatal alloimmune thrombocytopenia: recommendations for evidence-based practice, an international approach
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Lieberm, L, Greinacher, A, Murphy, MF, Bussel, J, Bakchoul, T, Corke, S, Kjae, M, Kjeldsen-Kragh, J, Bertrand, G, Oepkes, D, Bake, JM, Hum, H, Masse, E, Kapla, C, Arnold, DM, Baidya, S, Ryan, G, Savoia, H, Landry, D, Shehata, N, Lieberm, L, Greinacher, A, Murphy, MF, Bussel, J, Bakchoul, T, Corke, S, Kjae, M, Kjeldsen-Kragh, J, Bertrand, G, Oepkes, D, Bake, JM, Hum, H, Masse, E, Kapla, C, Arnold, DM, Baidya, S, Ryan, G, Savoia, H, Landry, D, and Shehata, N
- Abstract
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) may result in severe bleeding, particularly fetal and neonatal intracranial haemorrhage (ICH). As a result, FNAIT requires prompt identification and treatment; subsequent pregnancies need close surveillance and management. An international panel convened to develop evidence-based recommendations for diagnosis and management of FNAIT. A rigorous approach was used to search, review and develop recommendations from published data for: antenatal management, postnatal management, diagnostic testing and universal screening. To confirm FNAIT, fetal human platelet antigen (HPA) typing, using non-invasive methods if quality-assured, should be performed during pregnancy when the father is unknown, unavailable for testing or heterozygous for the implicated antigen. Women with a previous child with an ICH related to FNAIT should be offered intravenous immunoglobulin (IVIG) infusions during subsequent affected pregnancies as early as 12 weeks gestation. Ideally, HPA-selected platelets should be available at delivery for potentially affected infants and used to increase the neonatal platelet count as needed. If HPA-selected platelets are not immediately available, unselected platelets should be transfused. FNAIT studies that optimize antenatal and postnatal management, develop risk stratification algorithms to guide management and standardize laboratory testing to identify high risk pregnancies are needed.
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- 2019
14. How clinically important are non-D Rh antibodies?
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Healsmith, S, Savoia, H, Kane, SC, Healsmith, S, Savoia, H, and Kane, SC
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INTRODUCTION: The advent of RhD immunoglobulin prophylaxis to prevent maternal RhD alloimmunization has reduced the incidence of this condition and its associated poor outcomes. Consequently, non-D Rh antibodies now account for a greater proportion of alloimmunized pregnancies. These antibodies have been the subject of comparatively little research. This study investigated the incidence and clinical outcome of pregnancies affected by non-D Rh alloimmunization at an Australian tertiary maternity service. MATERIAL AND METHODS: This was a retrospective study of all pregnancies with non-D Rh antibodies (namely anti-C, -E, -c, -e, -Cw as well as the compound antibodies anti-CD, -cE and -ce) managed at the Royal Women's Hospital, Victoria, Australia, from 2009 to 2013 inclusive. Information collected included maternal demographics, details of the antibodies, course of the pregnancy and neonatal outcomes. RESULTS: During the study period, 115 non-D Rh alloimmunized pregnancies were identified in 102 mothers. Forty-nine pregnancies reached the critical titer (> 16) from non-D Rh alone and 11 fetuses received intrauterine red blood cell transfusion. Labor was induced or cesarean section performed in 38 cases. Forty-three neonates were admitted to the special care nursery and 59 received phototherapy. Nine received treatment for anemia and 10 neonates received intravenous immunoglobulin. CONCLUSIONS: Non-D Rh alloimmunization is a relatively uncommon complication of pregnancy, occurring in only .33% of pregnancies in the study period. It can lead to significant fetal/neonatal morbidity (and may lead to mortality). The most severe outcomes (including perinatal deaths) were mostly associated with the compound antibodies anti-CD and anti-cE, or a non-D Rh antibody in conjunction with anti-D.
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- 2019
15. Vox Sanguinis International Forum on paediatric indications for blood component transfusion
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Bruun, MT, Yazer, MH, Spinella, PC, Titlestad, K, Lozano, M, Delaney, M, Lejdarova, H, Pavlova, D, Trakhtman, P, Starostin, N, Zhiburt, E, van Kraaij, MGJ, Huisman, E, Kutner, JM, Sakashita, AM, Yokoyama, APH, Zubicaray, J, Sevilla, J, Okazaki, H, Hiwatari, M, Nagura, Y, Manzini, PM, Facco, G, Pecoraro, C, Singh, L, Hans, R, Sharma, RR, Kumar, P, Wikman, A, Deschmann, E, Kaur, H, Lam, JCM, Ho, SKY, Koh, PL, Moss, R, New, HV, Kinmonth, A, Comande, M, Savoia, H, Crighton, G, Yacobovich, J, Yahalom, V, Lau, W, Bruun, MT, Yazer, MH, Spinella, PC, Titlestad, K, Lozano, M, Delaney, M, Lejdarova, H, Pavlova, D, Trakhtman, P, Starostin, N, Zhiburt, E, van Kraaij, MGJ, Huisman, E, Kutner, JM, Sakashita, AM, Yokoyama, APH, Zubicaray, J, Sevilla, J, Okazaki, H, Hiwatari, M, Nagura, Y, Manzini, PM, Facco, G, Pecoraro, C, Singh, L, Hans, R, Sharma, RR, Kumar, P, Wikman, A, Deschmann, E, Kaur, H, Lam, JCM, Ho, SKY, Koh, PL, Moss, R, New, HV, Kinmonth, A, Comande, M, Savoia, H, Crighton, G, Yacobovich, J, Yahalom, V, and Lau, W
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- 2019
16. Vox Sanguinis International Forum on paediatric indications for blood component transfusion: Summary.
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Bruun, MT, Yazer, MH, Spinella, PC, Titlestad, K, Lozano, M, Delaney, M, Lejdarová, H, Pavlova, DE, Trakhtman, P, Starostin, N, Zhiburt, E, van Kraaij, MGJ, Huisman, E, Kutner, JM, Sakashita, AM, Yokoyama, APH, Zubicaray, J, Sevilla, J, Okazaki, H, Hiwatari, M, Nagura, Y, Manzini, PM, Facco, G, Avdis, C, Singh, L, Hans, R, Sharma, RR, Kumar, P, Wikman, A, Deschmann, E, Kaur, H, Mei, JLC, Ying, SHK, Pei Lin, K, New, HV, Moss, R, Kinmonth, A, Comande, M, Savoia, H, Crighton, G, Yacobovich, J, Yahalom, V, Lau, W, Bruun, MT, Yazer, MH, Spinella, PC, Titlestad, K, Lozano, M, Delaney, M, Lejdarová, H, Pavlova, DE, Trakhtman, P, Starostin, N, Zhiburt, E, van Kraaij, MGJ, Huisman, E, Kutner, JM, Sakashita, AM, Yokoyama, APH, Zubicaray, J, Sevilla, J, Okazaki, H, Hiwatari, M, Nagura, Y, Manzini, PM, Facco, G, Avdis, C, Singh, L, Hans, R, Sharma, RR, Kumar, P, Wikman, A, Deschmann, E, Kaur, H, Mei, JLC, Ying, SHK, Pei Lin, K, New, HV, Moss, R, Kinmonth, A, Comande, M, Savoia, H, Crighton, G, Yacobovich, J, Yahalom, V, and Lau, W
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- 2019
17. Misinterpretation of blood group and antibody screen leading to serious errors in RhD immunoglobulin administration: A report on first two years of data from Serious Transfusion Incident Reporting program.
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Akers, C, Savoia, H, Kane, S, Crispin, P, Keegan, A, Wood, E, Glazebrook, B, Bielby, L, Davis, AK, Akers, C, Savoia, H, Kane, S, Crispin, P, Keegan, A, Wood, E, Glazebrook, B, Bielby, L, and Davis, AK
- Abstract
The Serious Transfusion Incident Reporting program (STIR) commenced haemovigilance in relation to RhD immunoglobulin (Ig) administration in 2015. During two years of reporting, 21 reports relating to RhD Ig administration were received. Thirty-three percent (7/21) were related to omission of RhD Ig, putting women at risk of RhD alloimmunisation and adverse consequences in future pregnancies. A recent case reported to STIR highlights poor communication and misinterpretation of pathology results leading to significant morbidity from haemolysis in the fetus. STIR makes recommendations related to education of staff and communication between clinical and laboratory staff to improve the safety of patient care.
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- 2019
18. Maternal HPA-1a antibody level and its role in predicting the severity of Fetal/Neonatal Alloimmune Thrombocytopenia: a systematic review
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Kjaer, M, Bertrand, G, Bakchoul, T, Massey, E, Baker, JM, Lieberman, L, Tanael, S, Greinacher, A, Murphy, MF, Arnold, DM, Baidya, S, Bussel, J, Hume, H, Kaplan, C, Oepkes, D, Ryan, G, Savoia, H, Shehata, N, Kjeldsen-Kragh, J, Allard, S, Bianco, C, Callum, J, Compernolle, V, Fergusson, D, Fung, M, Nahirniak, S, Pavenski, K, Pink, J, So-Osman, C, Stanworth, SJ, Szczepiorkowski, ZM, Wood, E, Kjaer, M, Bertrand, G, Bakchoul, T, Massey, E, Baker, JM, Lieberman, L, Tanael, S, Greinacher, A, Murphy, MF, Arnold, DM, Baidya, S, Bussel, J, Hume, H, Kaplan, C, Oepkes, D, Ryan, G, Savoia, H, Shehata, N, Kjeldsen-Kragh, J, Allard, S, Bianco, C, Callum, J, Compernolle, V, Fergusson, D, Fung, M, Nahirniak, S, Pavenski, K, Pink, J, So-Osman, C, Stanworth, SJ, Szczepiorkowski, ZM, and Wood, E
- Abstract
BACKGROUND AND OBJECTIVES: In Caucasians, fetal/neonatal alloimmune thrombocytopenia (FNAIT) is most commonly due to maternal HPA-1a antibodies. HPA-1a typing followed by screening for anti-HPA-1a antibodies in HPA-1bb women may identify first pregnancies at risk. Our goal was to review results from previous published studies to examine whether the maternal antibody level to HPA-1a could be used to identify high-risk pregnancies. MATERIALS AND METHODS: The studies included were categorized by recruitment strategies: screening of unselected pregnancies or samples analyzed from known or suspected FNAIT patients. RESULTS: Three prospective studies reported results from screening programmes, and 10 retrospective studies focused on suspected cases of FNAIT. In 8 studies samples for antibody measurement, performed by the monoclonal antibody immobilization of platelet antigen (MAIPA) assay, and samples for determining fetal/neonatal platelet count were collected simultaneously. In these 8 studies, the maternal antibody level correlated with the risk of severe thrombocytopenia. The prospective studies reported high negative predictive values (88-95%), which would allow for the use of maternal anti-HPA-1a antibody level as a predictive tool in a screening setting, in order to identify cases at low risk for FNAIT. However, due to low positive predictive values reported in prospective as well as retrospective studies (54-97%), the maternal antibody level is less suited for the final diagnosis and for guiding antenatal treatment. CONCLUSION: HPA-1a antibody level has the potential to predict the severity of FNAIT.
- Published
- 2019
19. Audit of a paediatric directed donation programme
- Author
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Knuckey, M I, Wood, E M, and Savoia, H F
- Published
- 2003
20. Helicobacter pylori infection in the Australian community: current prevalence and lack of association with ABO blood groups
- Author
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ROBERTSON, M. S., CADE, J. F., SAVOIA, H. F., and CLANCY, R. L.
- Published
- 2003
21. The Significance of Subnormal Serum Vitamin B12 Concentration in Older People: A Case Control Study
- Author
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Metz, J., Bell, A. H., Flicker, L., Bottiglieri, T., Ibrahim, J., Seal, E., Schultz, D., Savoia, H., and Grath, K. M.
- Published
- 1996
22. The role of thrombophilia testing in women with adverse pregnancy outcomes
- Author
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Unterscheider, J, Kane, SC, Cutts, B, Savoia, H, Said, JM, Unterscheider, J, Kane, SC, Cutts, B, Savoia, H, and Said, JM
- Published
- 2017
23. Blood Group Antigen Matching Influence on Gestational Outcomes (AMIGO) study
- Author
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Delaney, M, Wikman, A, van de Watering, L, Schonewille, H, Verdoes, JP, Emery, SP, Murphy, MF, Staves, J, Flach, S, Arnold, DM, Kaufman, RM, Ziman, A, Harm, SK, Fung, M, Eppes, CS, Dunbar, NM, Buser, A, Meyer, E, Savoia, H, Abeysinghe, P, Heddle, N, Tinmouth, A, Traore, AN, Yazer, MH, Delaney, M, Wikman, A, van de Watering, L, Schonewille, H, Verdoes, JP, Emery, SP, Murphy, MF, Staves, J, Flach, S, Arnold, DM, Kaufman, RM, Ziman, A, Harm, SK, Fung, M, Eppes, CS, Dunbar, NM, Buser, A, Meyer, E, Savoia, H, Abeysinghe, P, Heddle, N, Tinmouth, A, Traore, AN, and Yazer, MH
- Abstract
BACKGROUND: Red blood cell (RBC) antigen matching policies to prevent alloimmunization in females of childbearing potential (FCP) vary between centers. To inform transfusion centers responsible for making decisions about matching policies for FCPs, the causal stimulus of the antibodies implicated in severe hemolytic disease of the fetus and newborn (HDFN) must be determined. STUDY DESIGN AND METHODS: We conducted a multinational retrospective study of women with offspring affected by severe HDFN requiring neonatal exchange transfusion and/or intrauterine transfusion. Mothers treated at centers that provide extended antigen-negative RBCs (MATCH, five centers) and those that do not (NoMATCH, nine centers) were compared. RESULTS: A total of 293 mothers had at least one affected pregnancy: 179 at MATCH centers and 114 at NoMATCH centers. Most alloimmunization (83%) was attributed to previous pregnancy: 3% to transfusion (two cases at MATCH, six at NoMATCH centers) and 14% undetermined (both antecedent transfusion and pregnancy). Only 50 mothers had received transfusions; 13 had HDFN due to anti-K at MATCH and four at NoMATCH centers. Most (12/13, 92%) of the anti-K HDFN cases at MATCH centers had K+ paternal antigen status. Mothers at the MATCH centers do not appear to be protected from HDFN due to K, C, c, and E antibodies, although the low number of FCPs who received transfusions precluded drawing firm conclusions. CONCLUSION: The causal stimulus of antibodies that cause HDFN is predominantly from previous pregnancy. Although extended RBC matching for FCPs may impart some protection from allosensitization, we were unable to show a positive effect, possibly because matching policies are not uniform and there was a small number of mothers who previously received transfusions.
- Published
- 2017
24. Fulminant liver failure in a neonate
- Author
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Clarke, NE, Gilby, D, Savoia, H, Oliver, MR, Rogerson, S, Clarke, NE, Gilby, D, Savoia, H, Oliver, MR, and Rogerson, S
- Abstract
Neonatal acute liver disease is relatively rare, with multiple different aetiologies including congenital infections, metabolic disorders, gestational alloimmune liver disease, haemophagocytic lymphohistiocytosis, and ischaemic injury. We report a case of neonatal liver failure in a preterm, growth-restricted infant, who underwent extensive investigation and was clinically diagnosed with gestational alloimmune liver disease, which was confirmed on post-mortem examination. We then discuss management of neonatal liver failure and gestational alloimmune liver disease, including maternal management in future pregnancies.
- Published
- 2016
25. Caring for pregnant women for whom transfusion is not an option. A national review to assist in patient care
- Author
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Kidson-Gerber, G., Kerridge, I., Farmer, Shannon, Stewart, C., Savoia, H., Challis, D., Kidson-Gerber, G., Kerridge, I., Farmer, Shannon, Stewart, C., Savoia, H., and Challis, D.
- Abstract
Postpartum haemorrhage (PPH) is the leading cause of maternal mortality and morbidity globally. Obstetric bleeding can be catastrophic and management is challenging, involving a coordinated multidisciplinary approach, which may include blood products. In settings where blood transfusion is not an option, either because of patient refusal (most commonly in Jehovah Witnesses) or because of unavailability of blood, management becomes even more challenging. Observational studies have demonstrated an association between refusal of blood products in major obstetric haemorrhage and increased morbidity and mortality. This review draws upon evidence in the literature, physiological principles and expert opinion for strategies and guidance to optimise the outcomes of pregnant women in whom blood transfusion is either refused or impossible. The importance of a multidisciplinary antenatal and perinatal management plan, including optimisation of haemoglobin and iron stores pre-delivery, blood loss minimisation, early haemorrhage control and postpartum anaemia treatment, is discussed.
- Published
- 2015
26. Transfusion service management of sickle-cell disease patients
- Author
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Yazer, M.H., primary, Lozano, M., additional, Crighton, G., additional, Greenway, A., additional, Comande, M., additional, Savoia, H., additional, Wood, E., additional, Gilli, S., additional, Castilho, L., additional, Saad, Sara T.O., additional, Galactéros, F., additional, Noizat-Pirenne, F., additional, Pazgal, I., additional, Stark, P., additional, Orlin, Y., additional, Perseghin, P., additional, Masera, N., additional, Cela, E., additional, Anguita, J., additional, Wikman, A., additional, and Delaney, M., additional
- Published
- 2015
- Full Text
- View/download PDF
27. Severe fetal ischaemic brain injury caused by homozygous protein C deficiency
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Stutterd, C., primary, Savoia, H., additional, Fink, A. M., additional, and Stark, Z., additional
- Published
- 2013
- Full Text
- View/download PDF
28. IVIG—Is It the Answer? Maternal Administration of Immunoglobulin for Severe Fetal Red Blood Cell Alloimmunization During Pregnancy
- Author
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Connan, K., primary, Kornman, L., additional, Savoia, H., additional, Palma-Dias, R., additional, and Rowlands, S., additional
- Published
- 2011
- Full Text
- View/download PDF
29. Neonatal transfusions
- Author
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New, H. V., primary, Stanworth, S. J., additional, Engelfriet, C. P., additional, Reesink, H. W., additional, McQuilten, Z. K., additional, Savoia, H. F., additional, Wood, E. M., additional, Olyntho, S., additional, Trigo, F., additional, Wendel, S., additional, Lin, Y., additional, Hume, H., additional, Petäjä, J., additional, Krusius, T., additional, Villa, S., additional, Ghirardello, S., additional, Von Lindern, J., additional, Brand, A., additional, Hendrickson, J. E., additional, Josephson, C. D., additional, Strauss, R. G., additional, Luban, N. L. C., additional, and Paul, W., additional
- Published
- 2008
- Full Text
- View/download PDF
30. Reference ranges for hemostatic parameters in children
- Author
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Monagle, P., primary, Ignjatovic, V., additional, Barnes, C., additional, Newall, F., additional, Campbell, J., additional, Savoia, H., additional, and Furmedge, J., additional
- Published
- 2003
- Full Text
- View/download PDF
31. Helicobacter pyloriinfection in the Australian community: current prevalence and lack of association with ABO blood groups
- Author
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Robertson, M. S., primary, Cade, J. F., additional, Savoia, H. F., additional, and Clancy, R. L., additional
- Published
- 2003
- Full Text
- View/download PDF
32. Increased tolerance to endotoxin by granulocyte-macrophage colony-stimulating factor-deficient mice.
- Author
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Basu, S, primary, Dunn, A R, additional, Marino, M W, additional, Savoia, H, additional, Hodgson, G, additional, Lieschke, G J, additional, and Cebon, J, additional
- Published
- 1997
- Full Text
- View/download PDF
33. T cell lymphoid aggregates in bone marrow in idiopathic hypereosinophilic syndrome.
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Metz, J, primary, McGrath, K M, additional, Savoia, H F, additional, Begley, C G, additional, and Chetty, R, additional
- Published
- 1993
- Full Text
- View/download PDF
34. IVIG -- is it the answer? Maternal administration of immunoglobulin for severe fetal red blood cell alloimmunisation during pregnancy: a case series.
- Author
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Connan K, Kornman L, Savoia H, Palma-Dias R, and Rowlands S
- Published
- 2009
- Full Text
- View/download PDF
35. Arterial thromboembolic disease: a single-centre case series study.
- Author
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Monagle P, Newall F, Barnes C, Savoia H, Campbell J, Wallace T, and Crock C
- Published
- 2008
- Full Text
- View/download PDF
36. Increased Tolerance to Endotoxin by Granulocyte-Macrophage Colony-Stimulating Factor-Deficient Mice
- Author
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Basu, S., Dunn, A. R., Marino, M. W., Savoia, H., Hodgson, G., Graham Lieschke, and Cebon, J.
- Subjects
Immunology ,Immunology and Allergy - Abstract
The contribution of granulocyte-macrophage CSF (GM-CSF) to endotoxin-mediated septic shock has been assessed by treating GM-CSF-deficient mice with LPS. Hypothermia and loss in body weight were markedly attenuated in LPS-treated GM-CSF-deficient mice compared with similarly treated control mice; moreover, the levels of circulating IFN-gamma, IL-1alpha, and IL-6 were lower in LPS-treated GM-CSF-deficient mice than LPS-treated control mice. Intriguingly, the peak levels of TNF-alpha in response to LPS treatment were the same in the serum of GM-CSF-deficient mice and control mice, although in GM-CSF-deficient mice, TNF-alpha persisted longer. Activation of macrophages by LPS, resulting in expression of cytokines including TNF-alpha and IL-1, is thought to underlie endotoxin-mediated effects. Accordingly, the response of peritoneal macrophages from GM-CSF-deficient mice to LPS was studied in vitro. LPS-stimulated peritoneal macrophages from GM-CSF-deficient mice produced significantly less IL-1alpha and nitric oxide than macrophages from wild-type mice, although there was no difference in TNF-alpha production. Collectively, these observations indicate that GM-CSF contributes to cytokine production in LPS-mediated septic shock, and that the attenuated production of these secondary cytokines (IFN-gamma, IL-1alpha, and IL-6) may contribute to the endotoxin-resistant phenotype of GM-CSF-deficient mice.
37. A serum-free culture model for studying the differentiation of human dendritic cells from adult CD34+ progenitor cells
- Author
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Luft T, Kc, Pang, Thomas E, Cj, Bradley, Savoia H, Trapani J, and Jonathan Cebon
- Subjects
Adult ,Cell Culture Techniques ,Humans ,Antigens, CD34 ,Cell Differentiation ,Dendritic Cells ,Flow Cytometry ,Hematopoietic Stem Cells ,Culture Media, Serum-Free - Abstract
The antigen-presenting capacity of dendritic cells (DCs) makes them attractive potential cellular adjuvants for vaccination strategies. Currently, most in vitro culture systems for the production of these DCs include serum. However, this is undesirable because serum contains growth factors that vary between individuals and could affect DC development. Unless the patient's own serum is used, foreign antigens and the risk of infection will detract from the usefulness of these cells in clinical strategies. In this study we investigated the production of DCs from CD34+ progenitor cells of cancer patients or normal donors under serum-free conditions. We have established a model system for the investigation of DC development and maturation. Dendritic cells that developed from myeloid precursors accumulated after 2 weeks in an intermediate CD1a , CD80-, CD83-, CD86- stage. Intermediate DCs adhered to plastic surfaces, expressed Birbeck granules, and were negative for CD2 and CD14. In the presence of granulocyte-macrophage colony-stimulating factor and tumor necrosis factor-alpha, interleukin-4 promoted the development of these stages. Spontaneous maturation of intermediate DCs into fully activated DCs expressing CD83 and costimulatory molecules occurred asynchronously over the ensuing 2 to 3 weeks. This maturation involved increased expression of CD80, CD83, CD86, CMRF-44, HLA-A, -B, -C, and -DR as well as downregulation of CD1a and CD11b. Activated DCs are characterized by the lack of adherence to plastic surfaces and the absence of Birbeck granules. By day 28, these cells were nonphagocytic, potent antigen-presenting cells with an irreversible phenotype. This serum-free system offers advantages in that the process of differentiation and maturation of committed DCs is extended over a period of more than 28 days, allowing investigators to study the effects of individual cytokines or other supplements during distinct phases of DC development in a defined environment.
38. Diagnosis and management of iron deficiency anaemia: A clinical update
- Author
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Pasricha, S. -R S., Flecknoe-Brown, S. C., Katrina Allen, Gibson, P. R., Mcmahon, L. P., Olynyk, J. K., Roger, S. D., Savoia, H. F., Tampi, R., Thomson, A. R., Wood, E. M., and Robinson, K. L.
39. Warfarin therapy in children who require long-term total parenteral nutrition.
- Author
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Newall F, Barnes C, Savoia H, Campbell J, and Monagle P
- Published
- 2003
- Full Text
- View/download PDF
40. Continuous reference intervals for holotranscobalamin, homocysteine and folate in a healthy paediatric cohort.
- Author
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Smith JD, Karlaftis V, Hearps S, Attard C, Savoia H, Campbell J, and Monagle P
- Subjects
- Humans, Child, Child, Preschool, Adolescent, Female, Male, Infant, Reference Values, Vitamin B 12 blood, Cohort Studies, Infant, Newborn, Biomarkers blood, Homocysteine blood, Folic Acid blood, Transcobalamins analysis, Transcobalamins metabolism
- Abstract
Background: The detection of deficiencies in B
12 and folate children is important. However, despite the availability of various markers to assess B12 and folate metabolism, there are limited studies describing the reference intervals (RIs) and changes during growth and development for these markers in healthy children., Methods: Using samples collected from 378 children aged 30 days-< 18 years, we derived continuous RIs for holotranscobalamin, homocysteine and red cell folate., Results: The lower RI for holotranscobalamin was lowest at birth, rising during early childhood and then declining following ages 4-6 years whereas red cell folate was highest early in life and then declined steadily towards adulthood. Total homocysteine, reflective of both B12 and folate status was elevated early in life, reaching a nadir at age 2 and then increasing towards adulthood., Conclusions: Continuous central 95th percentile RI for holotranscobalamin, homocysteine and red cell folate for children ages 30 days to <18 years were established. Each marker shows dynamic changes throughout childhood and adolescence which will assist clinicians in more appropriately assessing B12 and folate status in this population., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.- Published
- 2024
- Full Text
- View/download PDF
41. Investigation for bacterial contamination of blood products implicated in suspected transfusion-transmitted bacterial infection.
- Author
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Clifford V, Gonis G, Crighton G, Savoia H, Gosbell I, and Daley AJ
- Subjects
- Humans, Bacteria, Transfusion Reaction, Bacterial Infections
- Published
- 2023
- Full Text
- View/download PDF
42. Changes in emergency department blood product use for major paediatric trauma following the implementation of a major haemorrhage protocol.
- Author
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Long E, Williams A, Babl FE, Kinmonth A, Tse WC, Palmer CS, Crighton G, Savoia H, Teague WJ, and Nystrup KB
- Subjects
- Child, Clinical Protocols, Emergency Service, Hospital, Hemorrhage etiology, Hemorrhage therapy, Humans, Observational Studies as Topic, Retrospective Studies, Trauma Centers, Blood Coagulation Disorders etiology, Blood Coagulation Disorders therapy, Wounds and Injuries complications
- Abstract
Objective: Fixed ratio blood product administration may improve outcomes in trauma patients with massive blood loss. The present study aimed to describe the impact of a major haemorrhage protocol (MHP) on the ratio of blood products administered for paediatric major trauma., Methods: Retrospective observational study in a state-designated paediatric major trauma centre in Melbourne, Australia. Children with major trauma who received blood products in the ED were identified from a hospital trauma registry. Blood product ratios before, during and after implementation of a hospital MHP were compared in consecutive 2 year blocks., Results: Over a 6 year period, 767 major trauma patients were identified, of whom 47 received blood products in the ED and were included in the analysis; 14 pre-MHP implementation, 24 during-MHP implementation and nine post-MHP implementation. No patients received blood products at a ratio of 1:1:1 for red blood cells:fresh frozen plasma:platelets, respectively, during any time period. In this cohort of predominantly blunt trauma, blood products were infrequently administered in the ED because of the low prevalence of massive blood loss. Coagulopathy and hypofibrinogenaemia were commonly observed, nearly half of included patients were managed operatively and one quarter did not survive their injuries., Conclusion: The implementation of a MHP did not change the ratio of blood product administration in this cohort of patients because of the infrequency of massive blood loss. Future studies may focus on the impact of treating coagulopathy and hypofibrinogenaemia on patient-centred outcomes., (© 2021 Australasian College for Emergency Medicine.)
- Published
- 2021
- Full Text
- View/download PDF
43. Postnatal intervention for the treatment of FNAIT: a systematic review.
- Author
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Baker JM, Shehata N, Bussel J, Murphy MF, Greinacher A, Bakchoul T, Massey E, Lieberman L, Landry D, Tanael S, Arnold DM, Baidya S, Bertrand G, Kjaer M, Kaplan C, Kjeldsen-Kragh J, Oepkes D, Savoia H, Ryan G, and Hume H
- Subjects
- Combined Modality Therapy, Fetal Diseases, Humans, Infant, Newborn, Intracranial Hemorrhages epidemiology, Intracranial Hemorrhages prevention & control, Platelet Count, Thrombocytopenia, Neonatal Alloimmune blood, Thrombocytopenia, Neonatal Alloimmune mortality, Adrenal Cortex Hormones therapeutic use, Immunoglobulins, Intravenous therapeutic use, Platelet Transfusion methods, Thrombocytopenia, Neonatal Alloimmune therapy
- Abstract
Objective: Fetal and neonatal alloimmune thrombocytopenia (FNAIT) is associated with life-threatening bleeding. This systematic review of postnatal management of FNAIT examined transfusion of human platelet antigen (HPA) selected or unselected platelets, and/or IVIg on platelet increments, hemorrhage and mortality., Study Design: MEDLINE, EMBASE and Cochrane searches were conducted until 11 May 2018., Result: Of 754 neonates, 382 received platelet transfusions (51%). HPA-selected platelets resulted in higher platelet increments and longer response times than HPA-unselected platelets. However, unselected platelets generally led to sufficient platelet increments to 30 × 10
9 /L, a level above which intracranial hemorrhage or other life-threatening bleeding rarely occurred. Platelet increments were not improved with the addition of IVIg to platelet transfusion., Conclusion: Overall, HPA-selected platelet transfusions were more effective than HPA-unselected platelets but unselected platelets were often effective enough to achieve clinical goals. Available studies do not clearly demonstrate a benefit for addition of IVIg to platelet transfusion.- Published
- 2019
- Full Text
- View/download PDF
44. Vox Sanguinis International Forum on paediatric indications for blood component transfusion.
- Author
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Bruun MT, Yazer MH, Spinella PC, Titlestad K, Lozano M, Delaney M, Lejdarová H, Pavlova D, Trakhtman P, Starostin N, Zhiburt E, van Kraaij MGJ, Huisman E, Kutner JM, Sakashita AM, Yokoyama APH, Zubicaray J, Sevilla J, Okazaki H, Hiwatari M, Nagura Y, Manzini PM, Facco G, Pecoraro C, Singh L, Hans R, Sharma RR, Kumar P, Wikman A, Deschmann E, Kaur H, Mei Lam JC, Ying Ho SK, Koh PL, Moss R, New HV, Kinmonth A, Comande M, Savoia H, Crighton G, Yacobovich J, Yahalom V, and Lau W
- Published
- 2019
- Full Text
- View/download PDF
45. How clinically important are non-D Rh antibodies?
- Author
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Healsmith S, Savoia H, and Kane SC
- Subjects
- Anemia therapy, Erythrocyte Transfusion, Female, Humans, Immunoglobulins, Intravenous therapeutic use, Infant, Newborn, Phototherapy, Pregnancy, Pregnancy Outcome, Retrospective Studies, Victoria, Isoantibodies immunology, Rh Isoimmunization
- Abstract
Introduction: The advent of RhD immunoglobulin prophylaxis to prevent maternal RhD alloimmunization has reduced the incidence of this condition and its associated poor outcomes. Consequently, non-D Rh antibodies now account for a greater proportion of alloimmunized pregnancies. These antibodies have been the subject of comparatively little research. This study investigated the incidence and clinical outcome of pregnancies affected by non-D Rh alloimmunization at an Australian tertiary maternity service., Material and Methods: This was a retrospective study of all pregnancies with non-D Rh antibodies (namely anti-C, -E, -c, -e, -C
w as well as the compound antibodies anti-CD, -cE and -ce) managed at the Royal Women's Hospital, Victoria, Australia, from 2009 to 2013 inclusive. Information collected included maternal demographics, details of the antibodies, course of the pregnancy and neonatal outcomes., Results: During the study period, 115 non-D Rh alloimmunized pregnancies were identified in 102 mothers. Forty-nine pregnancies reached the critical titer (> 16) from non-D Rh alone and 11 fetuses received intrauterine red blood cell transfusion. Labor was induced or cesarean section performed in 38 cases. Forty-three neonates were admitted to the special care nursery and 59 received phototherapy. Nine received treatment for anemia and 10 neonates received intravenous immunoglobulin., Conclusions: Non-D Rh alloimmunization is a relatively uncommon complication of pregnancy, occurring in only .33% of pregnancies in the study period. It can lead to significant fetal/neonatal morbidity (and may lead to mortality). The most severe outcomes (including perinatal deaths) were mostly associated with the compound antibodies anti-CD and anti-cE, or a non-D Rh antibody in conjunction with anti-D., (© 2019 Nordic Federation of Societies of Obstetrics and Gynecology.)- Published
- 2019
- Full Text
- View/download PDF
46. Fetal and neonatal alloimmune thrombocytopenia: recommendations for evidence-based practice, an international approach.
- Author
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Lieberman L, Greinacher A, Murphy MF, Bussel J, Bakchoul T, Corke S, Kjaer M, Kjeldsen-Kragh J, Bertrand G, Oepkes D, Baker JM, Hume H, Massey E, Kaplan C, Arnold DM, Baidya S, Ryan G, Savoia H, Landry D, and Shehata N
- Subjects
- Antigens, Human Platelet blood, Female, Humans, Infant, Newborn, Pregnancy, Evidence-Based Medicine, Fetal Diseases diagnosis, Fetal Diseases drug therapy, Fetal Diseases epidemiology, Immunoglobulins, Intravenous therapeutic use, Intracranial Hemorrhages blood, Intracranial Hemorrhages diagnosis, Intracranial Hemorrhages drug therapy, Intracranial Hemorrhages epidemiology, Thrombocytopenia, Neonatal Alloimmune blood, Thrombocytopenia, Neonatal Alloimmune diagnosis, Thrombocytopenia, Neonatal Alloimmune drug therapy, Thrombocytopenia, Neonatal Alloimmune epidemiology
- Abstract
Fetal and neonatal alloimmune thrombocytopenia (FNAIT) may result in severe bleeding, particularly fetal and neonatal intracranial haemorrhage (ICH). As a result, FNAIT requires prompt identification and treatment; subsequent pregnancies need close surveillance and management. An international panel convened to develop evidence-based recommendations for diagnosis and management of FNAIT. A rigorous approach was used to search, review and develop recommendations from published data for: antenatal management, postnatal management, diagnostic testing and universal screening. To confirm FNAIT, fetal human platelet antigen (HPA) typing, using non-invasive methods if quality-assured, should be performed during pregnancy when the father is unknown, unavailable for testing or heterozygous for the implicated antigen. Women with a previous child with an ICH related to FNAIT should be offered intravenous immunoglobulin (IVIG) infusions during subsequent affected pregnancies as early as 12 weeks gestation. Ideally, HPA-selected platelets should be available at delivery for potentially affected infants and used to increase the neonatal platelet count as needed. If HPA-selected platelets are not immediately available, unselected platelets should be transfused. FNAIT studies that optimize antenatal and postnatal management, develop risk stratification algorithms to guide management and standardize laboratory testing to identify high risk pregnancies are needed., (© 2019 British Society for Haematology and John Wiley & Sons Ltd.)
- Published
- 2019
- Full Text
- View/download PDF
47. Misinterpretation of blood group and antibody screen leading to serious errors in RhD immunoglobulin administration: A report on first two years of data from Serious Transfusion Incident Reporting program.
- Author
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Akers C, Savoia H, Kane S, Crispin P, Keegan A, Wood E, Glazebrook B, Bielby L, and Davis AK
- Subjects
- Adult, Australia epidemiology, Blood Group Antigens, Blood Transfusion, Drug-Related Side Effects and Adverse Reactions etiology, Female, Fetomaternal Transfusion drug therapy, Humans, Immunoglobulins administration & dosage, Pregnancy, Pregnancy Complications, Hematologic drug therapy, Rh Isoimmunization etiology, Risk Management, Drug-Related Side Effects and Adverse Reactions epidemiology, Immunoglobulins adverse effects, Medication Errors, Perinatal Care, Rh Isoimmunization epidemiology, Rh-Hr Blood-Group System
- Abstract
The Serious Transfusion Incident Reporting program (STIR) commenced haemovigilance in relation to RhD immunoglobulin (Ig) administration in 2015. During two years of reporting, 21 reports relating to RhD Ig administration were received. Thirty-three percent (7/21) were related to omission of RhD Ig, putting women at risk of RhD alloimmunisation and adverse consequences in future pregnancies. A recent case reported to STIR highlights poor communication and misinterpretation of pathology results leading to significant morbidity from haemolysis in the fetus. STIR makes recommendations related to education of staff and communication between clinical and laboratory staff to improve the safety of patient care., (© 2018 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)
- Published
- 2019
- Full Text
- View/download PDF
48. Maternal HPA-1a antibody level and its role in predicting the severity of Fetal/Neonatal Alloimmune Thrombocytopenia: a systematic review.
- Author
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Kjaer M, Bertrand G, Bakchoul T, Massey E, Baker JM, Lieberman L, Tanael S, Greinacher A, Murphy MF, Arnold DM, Baidya S, Bussel J, Hume H, Kaplan C, Oepkes D, Ryan G, Savoia H, Shehata N, and Kjeldsen-Kragh J
- Subjects
- Antigens, Human Platelet immunology, Biomarkers blood, Female, Humans, Infant, Newborn, Integrin beta3, Maternal Serum Screening Tests methods, Platelet Count, Pregnancy, Thrombocytopenia, Neonatal Alloimmune epidemiology, Thrombocytopenia, Neonatal Alloimmune immunology, Antigens, Human Platelet blood, Thrombocytopenia, Neonatal Alloimmune blood
- Abstract
Background and Objectives: In Caucasians, fetal/neonatal alloimmune thrombocytopenia (FNAIT) is most commonly due to maternal HPA-1a antibodies. HPA-1a typing followed by screening for anti-HPA-1a antibodies in HPA-1bb women may identify first pregnancies at risk. Our goal was to review results from previous published studies to examine whether the maternal antibody level to HPA-1a could be used to identify high-risk pregnancies., Materials and Methods: The studies included were categorized by recruitment strategies: screening of unselected pregnancies or samples analyzed from known or suspected FNAIT patients., Results: Three prospective studies reported results from screening programmes, and 10 retrospective studies focused on suspected cases of FNAIT. In 8 studies samples for antibody measurement, performed by the monoclonal antibody immobilization of platelet antigen (MAIPA) assay, and samples for determining fetal/neonatal platelet count were collected simultaneously. In these 8 studies, the maternal antibody level correlated with the risk of severe thrombocytopenia. The prospective studies reported high negative predictive values (88-95%), which would allow for the use of maternal anti-HPA-1a antibody level as a predictive tool in a screening setting, in order to identify cases at low risk for FNAIT. However, due to low positive predictive values reported in prospective as well as retrospective studies (54-97%), the maternal antibody level is less suited for the final diagnosis and for guiding antenatal treatment., Conclusion: HPA-1a antibody level has the potential to predict the severity of FNAIT., (© 2018 International Society of Blood Transfusion.)
- Published
- 2019
- Full Text
- View/download PDF
49. Blood Group Antigen Matching Influence on Gestational Outcomes (AMIGO) study.
- Author
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Delaney M, Wikman A, van de Watering L, Schonewille H, Verdoes JP, Emery SP, Murphy MF, Staves J, Flach S, Arnold DM, Kaufman RM, Ziman A, Harm SK, Fung M, Eppes CS, Dunbar NM, Buser A, Meyer E, Savoia H, Abeysinghe P, Heddle N, Tinmouth A, Traore AN, and Yazer MH
- Subjects
- Adult, Erythroblastosis, Fetal blood, Erythroblastosis, Fetal epidemiology, Female, Humans, Pregnancy, Retrospective Studies, Blood Group Antigens blood, Blood Grouping and Crossmatching, Fetomaternal Transfusion blood, Fetomaternal Transfusion epidemiology, Isoantibodies blood
- Abstract
Background: Red blood cell (RBC) antigen matching policies to prevent alloimmunization in females of childbearing potential (FCP) vary between centers. To inform transfusion centers responsible for making decisions about matching policies for FCPs, the causal stimulus of the antibodies implicated in severe hemolytic disease of the fetus and newborn (HDFN) must be determined., Study Design and Methods: We conducted a multinational retrospective study of women with offspring affected by severe HDFN requiring neonatal exchange transfusion and/or intrauterine transfusion. Mothers treated at centers that provide extended antigen-negative RBCs (MATCH, five centers) and those that do not (NoMATCH, nine centers) were compared., Results: A total of 293 mothers had at least one affected pregnancy: 179 at MATCH centers and 114 at NoMATCH centers. Most alloimmunization (83%) was attributed to previous pregnancy: 3% to transfusion (two cases at MATCH, six at NoMATCH centers) and 14% undetermined (both antecedent transfusion and pregnancy). Only 50 mothers had received transfusions; 13 had HDFN due to anti-K at MATCH and four at NoMATCH centers. Most (12/13, 92%) of the anti-K HDFN cases at MATCH centers had K+ paternal antigen status. Mothers at the MATCH centers do not appear to be protected from HDFN due to K, C, c, and E antibodies, although the low number of FCPs who received transfusions precluded drawing firm conclusions., Conclusion: The causal stimulus of antibodies that cause HDFN is predominantly from previous pregnancy. Although extended RBC matching for FCPs may impart some protection from allosensitization, we were unable to show a positive effect, possibly because matching policies are not uniform and there was a small number of mothers who previously received transfusions., (© 2017 AABB.)
- Published
- 2017
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50. Caring for pregnant women for whom transfusion is not an option. A national review to assist in patient care.
- Author
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Kidson-Gerber G, Kerridge I, Farmer S, Stewart CL, Savoia H, and Challis D
- Subjects
- Anemia etiology, Anemia therapy, Female, Humans, Pregnancy, Prenatal Care, Risk Assessment, Blood Banks supply & distribution, Blood Transfusion, Postpartum Hemorrhage therapy, Treatment Refusal
- Abstract
Postpartum haemorrhage (PPH) is the leading cause of maternal mortality and morbidity globally. Obstetric bleeding can be catastrophic and management is challenging, involving a coordinated multidisciplinary approach, which may include blood products. In settings where blood transfusion is not an option, either because of patient refusal (most commonly in Jehovah Witnesses) or because of unavailability of blood, management becomes even more challenging. Observational studies have demonstrated an association between refusal of blood products in major obstetric haemorrhage and increased morbidity and mortality. This review draws upon evidence in the literature, physiological principles and expert opinion for strategies and guidance to optimise the outcomes of pregnant women in whom blood transfusion is either refused or impossible. The importance of a multidisciplinary antenatal and perinatal management plan, including optimisation of haemoglobin and iron stores pre-delivery, blood loss minimisation, early haemorrhage control and postpartum anaemia treatment, is discussed., (© 2015 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.)
- Published
- 2016
- Full Text
- View/download PDF
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