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  • ISSN: 2333-6684
    Early Online
    Volume 7, Issue 1
    Editorial
    Daniela O W Rodrigues*, Olivia F Santos, Renato L Medeiros, Tassia M M Paz, Thais S Esposito, Rodrigo M Almeida, Augusto CA Santos, Jessica D Rezende, Jordana AS Lopes, and Maisa A Ribeiro
    Severe acute respiratory Guidance for assisting patients with sickle cell disease to reduce the impact of the Covid-19 pandemic syndrome coronavirus 2, also known as COVID -19, has spread to more than 213 countries with almost 12,6 million cases as July 2020 since first reported [1-3].
    Review Article
    Sabah Bouhou*, Khadija Lahjouji, and Mohammed Benajiba
    At the end of 2019, a new coronavirus (SARS-CoV-2) was identified in people living in the city of Wuhan in China. The first people identified as infected went to the city’s seafood market, where live animals were also sold. Since the appearance of the first cases in Wuhan, the epidemic has spread to the international scale with actually at 18 May 4.679.511 cases and 315.005 deaths worldwide. The pandemic is considered by international scientific societies to have an impact on blood donation and transfusion activities at the level of transfusion establishments on an international scale. Efforts must, therefore, be made at the level of the transfusion centers to ensure proper management of this health crisis at SARS-Cov-2.
    The National Blood Center of Morocco has demonstrated a great reactivity and a great adaptability since the beginning of the epidemic according to the evolution of scientific data to ensure the availability and safety of blood products to patients, sanguins aux patients.
    Research Article
    Irfan Yavasoglu*, Eylem Akkaya, Oktay Asici, Okan Firat, Filiz Ergin, Mustafa Yilmaz, Gurhan Kadikoylu, and Zahit Bolaman
    Glucose transporter protein-1 GLUT-1 is expressed on some solid tumors and plasma cells.In this prospective study, we aimed the effect of serum GLUT-1 levels on leucocyte and thrombocyte engraftment in multiple myeloma (MM) patients during autologous stem cell transplantation. The fifty-one patients with MM included in the study. GLUT-1 levels at autologous stem cell harvest of patients with myeloma were determined by ELISA. The results analyzed with SPSS for Windows version 19.0 module. A total of 51 patients (25 males, 26 females, mean age 58 ± 9 years) were evaluated. 26 patients were in complete remission and 25 had a very good response. The mean GLUT-1 level was 7.3 ± 2.3 ng / mL (min. 3.48-max.13.87). CD 34 was 5.2 x 106 / kg. Mean neutrophil engraftment time was 15.6 ± 4.1 / day and mean platelet engraftment time was 18.6 ± 5.2 / day. There was a positive correlation between GLUT-1 level and neutrophil engraftment (p=0,004) and no correlation with thrombocyte engraftment. Pretransplant GLUT-1 levels are high in myeloma patients with partial remission and neutrophil engraftment is delayed at these patients whereas GLUT-1 level is low in myeloma patients with complete remission and posttransplantation neutrophil engraftment occurs early. And there was positive correlation with GLUT-1 levels in patients with partial remission according to complete remission (p<0,001). This study showed that GLUT-1 level is related to neutrophil engraftment and also a complete or partial remission rate.
    Banu Karaca, Sinem Namdaroglu, Alpay Ari, and Nilufer Bagriacik
    Aim: To evaluate the cross-match / transfusion (C / T) ratio, which is a new indicator used in blood transfusion centers, in terms of different clinics in our institution.
    Methods: The number of cross-matches and transfusions performed in our Blood Transfusion Center during the nine-month period between April 2018 and December 2018 were obtained from Hospital Information Management.A ratio of 1.2 and below is considered indicative of optimum blood usage.
    Results: During the 9-month study period 9407 cross-matches, and 8691 transfusions were performed included in the study was and the total number of was. The C / T ratio of our hospital in the study period was found to be 1.08 x 100. The best C / T ratios were seen in Departments of Cardiovascular Surgery and Plastic Reconstructive and Aesthetic Surgery. The worst ratio was 1.67 which was detected in Department of Chest Surgery, followed by 1.37 which was detected in Department of Infectious Diseases and Clinical Microbiology.
    Conclusions: It can be stated that, the C / T ratios in our hospital have reached the international standards of blood centers.
    Viera Fabryova*, Angelika Vasiľova, Michal Bada, Andrea Kollarova, Zuzana Laluhova Striežencova, Michaela Macichova, Katarína Gbúrova, Martin Fabry, and Branislav Fabry
    Objectives: The paper presents results of 27- year epidemiological study of screening and follow-up haemoglobinopathies in Slovakia.
    Methods: Between 1993 – 2020, in two research centres in Bratislava and in one centre in Kosice, carriers of beta-thalassaemic genes or other haemoglobinopathies were searched for. Diagnosis was performed by haematologists, whereby the family history was evaluated, together with overall clinical condition, blood count and blood smear, iron and haemolysis parameters, mutations of hereditary haemochromatosis, and haemoglobin electrophoresis testing. Patients with a probability of having a haemoglobinopathy were sent to the research facilities.
    Results: 415 patients were genetically examined. In 385 (92.77%), of them heterozygote beta-thalassaemia was confirmed (in 98 families). Five patients were diagnosed for delta, beta-thalassaemia (1.20%), 4 patients (0.97%) for delta, beta-gama1-thalasaemia or persistent hereditary fetal haemoglobin. In total we diagnosed 20 mutations of beta-globin gene. The most frequent mutations were IVS 1.110 (G-A), IVS II-1(G-A) and codon 39. Evidence of haemoglobin S (heterozygote sickle cell anaemia), was also notable in two non-relative children, whose fathers were of African origin, in one patient of Ghana and in one patient from Nigeria. One female patient was followed up for haemoglobin Santa Ana (mutation de novo), one family for haemoglobin Bishopstown and one patient for mutation KLF1 gene.
    In our group were 14 patients (3.17%) diagnosed for alpha-thalassaemia.
    All patients were heterozygotes, only one female patient from Macedonia was a double heterozygote for beta-thalasaemie.
    Clinicaly all of the patients had a minor or intermedia form.
    In the years of 2012-2019 we observed 12 pregnant patients with beta-thalasaemie. One of them had multiple pregnancies, all deliveries were without haematological complications.
    Conclusions: The study showed that in the west and eastern Slovakia there is a higher number for thalassaemia and other haemoglobinopathies. Mutations are of historical origin or over the past years we have recorded an increase number of mutations from areas with high incidence of haemoglobinopathies. It is necessary to continue in search of pathological gene carriers to avoid serious forms of the disease.
    Research Article
    Anver Kuliev*, Tatiana Pakhalchuk, Geraldine San Ramon, and Svetlana Rechitsky
    Hemoglobinopathies are the most frequent indication for preimplantation genetic testing (PGT), performed for more than twenty years to provide an option for couplers at risk to avoid the birth of an affected offspring and have a healthy children of their own. We present here our experience of 684 PGT cycles for hemoglobinopathies, resulting in birth of 240 unaffected children, which is a part of our overall PGT series of 5883 PGT cycles for monogenic disorders (PGT-M), with 2,332 resulting births, free of genetic disorders. Although PGT-M was mainly offered to heterozygous carries, 15 cycles were performed for homozygous thalassemia patients, as PGT-M is the only option for them to have an unaffected children. Increasing number of PGT cycles (188 cycles) are performed together with preimplantation HLA typing (PGT-HLA), as a means for having an access to HLA compatible stem cell transplantation for the affected children in the family. The available experience on the results of stem cell transplantation treatment, using donors produced by PGT-HLA shows an extremely high success rate of radical treatment. The accumulated experience demonstrates considerable progress in using PGT for prevention and radical treatment of hemoglobinopathies.
    Research Article
    Omkareshwar Patil*and Jayaprakash CS
    Background: Blood safety is a major issue all over world-wide in transfusion medicine. For this reason, blood donor selection is important for the safety of donors and recipients as well as for maintaining an adequate blood supply. Detailed analysis of various causes for deferral of blood donors may helpful for medical personnel to curb the barriers that impede the blood donation. The aim of this study was to analyze the rate of deferral and evaluate the various causes of deferral in blood donors to achieving 100% acceptance.
    Methods: This is an Observational descriptive record-based study over a time period of 1 year from January 2019 to December 2019. Donor acceptance criteria were followed according to the National guidelines for blood donation. Data were collected from the Donor deferral registry with respect to age and Gender. The causes of deferral were categorized as temporary and permanent
    Result: A total of 9059 donors presenting to the blood bank during the study period, 7713 (85.14%), were accepted for donation, and 1346 (14.86%), were deferred. Out of 1346 deferral, 898 (66.71%), were males and 448 (32.92%), were females. Among the deferred, 964 (71.48%), were deferred for temporary reasons and 382 (28.52%), for permanent reasons. Low haemoglobin was a common cause for temporary deferral (27.82%), and hypertension for permanent deferral (97.12%), constituting 27.56% of the total deferrals.
    Choudhry VP and Arora JS
    Thalassemia is most frequent inherited genetic disorders in the World. There are 270 million carriers Worldwide however it has high prevalence in the Mediterranean area & South East Asia. Over the last three to four decades there has been major development in the management of thalassemia & nearly 95% of children are surviving who were born after 1995 in the developing countries. The current protocols recommends that pre-transfusion hemoglobin should be maintained around 10 gm/dl by repeated leukodepleted & NAT tested blood transfusions and serum ferritin should be maintained between 800-1000 ng/ml by adequate chelation therapy to prevent complications of iron overload. Hematopoietic stem cell transplant offers complete cure and the results of HSCT have significantly improved over the last two decades. It is unfortunate that sibling matched donors are available in 30% of cases. It is believed that with further improvement in HLA-matching techniques, conditioning regimens and management of graft versus host disease (GVHD) & veno-occlusive disease (VODs) the survivals in allo-HSCT or haplo-transplant will improve significantly & will become standard form of therapy in near future.
    Newer therapies in form of gene therapy, gene editing & drugs to correct ineffective therapy are at various stages of development & it is expected that with these newer therapies every child with thalassemia will have option of complete cure in future.
    Case Report
    Sebo Gene Wang, Nicholas C Hsu, Sebo Michelle Wang, Ming Chu Hsu, and Fu Nan Wang
    Multiple myeloma (MM) is a highly malignant cancer characterized by the proliferation and accumulation of monoclonal plasma cells in the bone marrow along with end-organ damage due to the underlying disorder. Despite the remarkable progress in the treatment of MM with the availability of novel agents and hematopoietic cell transplantations (HCTs), an overwhelming majority of patients relapse and the disease is generally considered incurable. Here we report a case of a 57-year old male with relapsed MM previously treated with standard of care therapies including high-dose chemotherapy, radiotherapy, and autologous HCT. Based on our previous success with mesenchymal stem cell (MSC)-based therapy and its favorable safety profile, allogeneic MSC infusions was offered as a treatment option. A daily dose of 5.0 × 108 MSCs was slowly administered intravenously (lasted about 1.5 hours) to the patient for ten consecutive days. Three months after the treatment, his laboratory findings returned to within normal ranges and MRI showed complete resolution of the lesions. There were no significant adverse effects after administration of MSCs during the course of treatment and follow-up. The patient has since been cancer-free and no longer suffered from osteoporosis, which is usually a life-long complication for patients with MM. This firstin-human study showed that a high cumulative dose of MSCs is a safe and curative treatment for MM.
    Commentary
    Jerard Seghatchian*
    CoV-2 infection-induced thrombotic thrombocytopenia purpura [TTP] is life-threatening event often observed amongst critically ill CoV-2 patients and intriguingly subsequent to vaccination, as a rare event, with an incidence about 10 cases per million vaccinated individuals, as characterised by blood clot combined with low platelet count. Nevertheless, it is unclear how vaccines that are not infective and based mainly on the characteristic of the viral spike proteins, could lead selectively to thrombotic event, unless a host predisposition to thrombotic events is already in place. Nevertheless this rare event open the door of Pandora box to a series of other important questions that remains to be fully investigated: i] Why the physiological responses to CoV-2 infection and the vaccine’ spike proteins are age- dependent and appears predominantly occurs in young female below the age 50?; ii] Why the type of blood clot forms by differing infection differs and only severely affects the unvaccinated populations? and how these events should be accurately diagnosed ?; iii] Where we stands on the balance the overall benefit of the vaccination, in building a solid protection barrier against infection versus the negligible rare risk of thrombotic even in certain predisposed groups?. The main objective of this invited commentary is to provide a personal viewpoint on the CoV-2 infection or vaccines- induced TTP and to explore the planed remedial action to survive COVID and to save some lives. While the race between, the emergence of fast spreading mutated virus, versus the limited therapeutic values of slow acting of vaccines therapy continue, the use of some innovative and safer alternative booster therapies for the immediate delivery of some multivariate -targeted neutralising antibodies is considered to be the best preventative and therapeutic strategies intervention that we do need right now urgently. In short while efforts in developing multivariate types of vaccines are still progressing, but because of the delayed mode of action of passive immunotherapy, taking up to 3-4 weeks to develop real protection against infection, and vaccines effectiveness not being 100%, vigilance is still the key element in the advancement of mass vaccination rollout to survive COVID.
    Jerard Seghatchian*
    This invited viewpoint commentary focussed on attempts made so far to prevent the spread CoV-2 variants infection through the targeted use of some safe and efficacious approved vaccines, combined with some alternative supportive approaches to optimise patient’s outcome, teaming up to mitigation and minimising some potential adverse events. In fact the challenges of overcoming vaccine hesitancy, in certain populations, remained unresolved problem worldwide, despite the fact that the team working approaches in the UK mass vaccination, combined with some added interventions and unwanted restrictions, found to be effective to tame the speed viral infection transmission and being highly instrumental in depressing and even breaking the link between infection to hospitalization and viral transmission.
    Review Article
    Fu Nan Wang*, Ming Chu Hsu, Sebo Ling Wang, Sebo Gene Wang, Wei Chun Chen, Tsung Dao Lee, Sebo Michelle Wang, and Howard Doong
    Coronavirus (Covid-19) has caused a global pandemic. Consequently, companies have manufactured vaccines to combat the spread of Covid-19 and protect those who become vaccinated. However, the current vaccines do not seem to be effective against the new variants of the virus that have emerged. Stem cell therapy could be an alternative. The immunomodulatory effects from stem cell therapy can inhibit the immune system overactivation consequently lowering the mortality rate by preventing or attenuating the cytokine storm caused by Covid-19. It can reduce time to recovery with its regenerative effects by repairing damages caused by Covid-19 and improving bodily functions. In addition, unlike most traditional medicine, no adverse effects have been observed after treatment. All this suggests that stem cell therapy is a promising and viable solution to combat and treat Covid-19.
    Case Report
    Richa Pawar, Monika Gupta*, Sonia Chhabra, Sant Prakash Kataria, Sunita Singh
    HPLC (High performance Liquid Chromatography) is a method of identification and quantification of hemoglobin variant. Transfusion acquired or apparent hemoglobinopathy is now not uncommon entity with the availability of HPLC. Asymptomatic carrier of abnormal hemoglobin variant may donate blood and when such blood unit transfused to another person, it results in erroneous peaks on chromatograms. These peaks are transient in nature and having low percentage of abnormal hemoglobin variant, create a diagnostic dilemma and chances of misdiagnosis. Here, we report a case of such transfusion induced hemoglobinopathy with peak at HbD window. On further workup, history of prior blood transfusion, negative family screening and decrease peak at HbD window on repeat testing after two weeks confirmed the diagnosis.
    Paulo Pereira*, Jerard Seghatchian
    Controlling the production of blood components is required by regulations such as the European and North American. All production processes have a predictable error under stable conditions. This error is recognized as an expected error. When special causes influence this error, it can be significant. Capability indexes allow measuring production performance by ranking it. When special causes are involved, these indexes suggest production instability. In this situation, taking action is required to return the process conditions to stability. The article introduces a series of capability indices. It discusses, in some depth, their mathematical models as well as their classification levels. A statistical technique for the control of blood component production is suggested.
    Commentaries
    Jerard Seghatchian*
    This invited viewpoint commentary, in the from of a multimedia activities content in concert with some personal inputs on some of opinions expressed based on my earlier publications are designed to fill some of the unmet needs of the medical community by reporting information pertaining to clinically relevant development i CoV-2 variants , stipulating the editorial independence of this author.
    Short Communication
    Jerard Seghatchian*
    Ever since March 2020, when WHO announced the COVID-19 pandemic, the world has been facing some unsurmountable healthcare and economical crises, due to imposed ever changing nature of CoV-2 variants. Several newer strategies including the use of some anti-inflammatory, anti-viral drug therapy and the use of convalescent plasma were tried internationally to deliver Cov-2 neutralising antibody [CCP-NAB] from recovered patients, by mobile plasma exchange therapy [PET] with the partial success. In parallel in order to reduce the rate of infection down to manageable levels attempts were made to achieving herd immunity, with some validated vaccines, an insurmountable challenge in views of enormous percentage of vaccines hesitancy and strong anti vaccine lobby and the vaccine efficiency not being 100%, there would always 5 to 30% non- responders depending on vaccines’ types, even after double jabs of vaccination. Moreover there will be large number asymptomatic individuals that would propagate exponentially the rate of infection, as we are witnessing with the current beta and delta fast spreading variant targeting younger populations, even when doubly vaccinated. Moreover considerable donor/recipient variabilities in the immunological and hematological responses to infectivity exist hence some holistic approach is needed to minimize potential toxicity of vaccine in certain population and eliminated prior to reinfusion of CCP and to provide an answer to the most intriguing questions - is the dynamics of variability’s observed early inflammatory-thrombotic patterns to infection and the delayed autoimmune antibody responses, are associated with the high affinity binding of viral spike proteins to ACE2 on the endothelium of cell surface, facilitating viral entry to cell machinery for the infection progression ?.
    In the current invited viewpoint commentary after a brief revisit of the scale of above unresolved challenges, some planned progression in provision of a purer, cleaner and new types of NAB –hyperconcentrates obtainable from various sources for emergency delivery of polyclonal NAB against all variants for emergency booster therapeutic purpose, fit for clinical trials are explored with the objective of helping to convert these challenges to opportunity with perseverance, while in the UK restriction is coming to end and we must learn how to coexist with the ever changing nature of the CoV-2 variants.
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