Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a newly discovered virus for which remdesivir is the only antiviral available. We report the occurrence of a mutation in RdRP ...(D484Y) following treatment with remdesivir in a 76-year-old female with post-rituximab B-cell immunodeficiency and persistent SARS-CoV-2 viremia. A cure was achieved after supplementation with convalescent plasma.
Blood transfusion is one of the most frequently used therapies worldwide and is associated with benefits, risks, and costs.
To develop a set of evidence-based recommendations for patient blood ...management (PBM) and for research.
The scientific committee developed 17 Population/Intervention/Comparison/Outcome (PICO) questions for red blood cell (RBC) transfusion in adult patients in 3 areas: preoperative anemia (3 questions), RBC transfusion thresholds (11 questions), and implementation of PBM programs (3 questions). These questions guided the literature search in 4 biomedical databases (MEDLINE, EMBASE, Cochrane Library, Transfusion Evidence Library), searched from inception to January 2018. Meta-analyses were conducted with the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) methodology and the Evidence-to-Decision framework by 3 panels including clinical and scientific experts, nurses, patient representatives, and methodologists, to develop clinical recommendations during a consensus conference in Frankfurt/Main, Germany, in April 2018.
From 17 607 literature citations associated with the 17 PICO questions, 145 studies, including 63 randomized clinical trials with 23 143 patients and 82 observational studies with more than 4 million patients, were analyzed. For preoperative anemia, 4 clinical and 3 research recommendations were developed, including the strong recommendation to detect and manage anemia sufficiently early before major elective surgery. For RBC transfusion thresholds, 4 clinical and 6 research recommendations were developed, including 2 strong clinical recommendations for critically ill but clinically stable intensive care patients with or without septic shock (recommended threshold for RBC transfusion, hemoglobin concentration <7 g/dL) as well as for patients undergoing cardiac surgery (recommended threshold for RBC transfusion, hemoglobin concentration <7.5 g/dL). For implementation of PBM programs, 2 clinical and 3 research recommendations were developed, including recommendations to implement comprehensive PBM programs and to use electronic decision support systems (both conditional recommendations) to improve appropriate RBC utilization.
The 2018 PBM International Consensus Conference defined the current status of the PBM evidence base for practice and research purposes and established 10 clinical recommendations and 12 research recommendations for preoperative anemia, RBC transfusion thresholds for adults, and implementation of PBM programs. The relative paucity of strong evidence to answer many of the PICO questions supports the need for additional research and an international consensus for accepted definitions and hemoglobin thresholds, as well as clinically meaningful end points for multicenter trials.
La sécurité transfusionnelle a été considérablement améliorée depuis les années 80 par l’élargissement des analyses microbiologiques de qualification du don réduisant ainsi les fenêtres sérologiques, ...la leucoréduction, et plus récemment la réduction des pathogènes dans le plasma et les concentrés plaquettaires. Les concentrés de globules rouges (CGR) restent le seul composé labile qui ne bénéficient pas encore en routine d’un procédé de réduction des pathogènes, qui pourrait permettre de réduire encore le risque bactérien, viral et parasitaire. Plusieurs firmes développent des technologies d’atténuation des pathogènes dans les CGR, dont les plus étudiés sont le procédé Mirasol® (Terumo BCT, association de riboflavine et UV, sur sang total) et Intercept™ (Cerus, amustaline ou S-303, sur CGR). Le procédé Intercept™ est celui dont le spectre couvre le plus grand nombre d’agents pathogènes, et dont le développement est le plus avancé. Le propos de notre présentation est de (1) exposer les différentes étapes de traitement d’un CGR par Intercept™, leur conséquences sur l’organisation du travail des plateaux de préparation des produits sanguins labiles, et l’état d’avancement de la mise à l’échelle de ce procédé pour une production optimisée, (2) réaliser une synthèse des études concernant Intercept pour les CGR : études précliniques, études cliniques chez le volontaire sain (recirculation, durée de vie), études de phase II et III chez des patients, en chirurgie et en hématologie, et (3) d’analyser les enjeux, les bénéfices attendus, les limites, les contraintes et la faisabilité du déploiement à large échelle d’une telle technique, dans un pays comme la France.
Background
New blood products are considered for treatment of patients with major hemorrhage. The aim of this report is to describe the current transfusion practices in Europe for patients with major ...hemorrhage and explore the need for new or modified blood products to ensure prehospital and in‐hospital blood supply.
Study Design and Method
The European Blood Alliance (EBA) Working Group on Innovation and New Blood Products' subgroup on major hemorrhage performed a survey among the EBA member states.
Results
The response rate was 58% (17 responses from 15 of the 26 EBA member states). Of these, sixteen (94%) provide massive transfusion packages (MTPs) with balanced ratio of red blood cells and plasma. Seven of the respondents included platelets from the start of treatment. Eleven (65%) provide prehospital blood products, mainly red cell concentrates or dried and/or thawed plasma with 5 days of extended storage. Two countries provide prehospital whole blood. Twelve respondents (71%) saw a need for implementation of new or modified blood components in their institution. The top three priorities were whole blood (12 of 12, 100%), dried plasma (8 of 12, 67%), and cold‐stored platelets (7 of 12, 58%).
Discussion
Current national guidelines for use of blood products in patients with major hemorrhage in Europe agree on the use of balanced transfusion, however the timing and source of platelets differ. Blood products for prehospital transfusion are available in several European countries. An interest in new or modified blood products for patients with major hemorrhage was observed, especially for whole blood.
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