The occurrence of chronic myeloid leukaemia (CML) in patients infected with the human immunodeficiency virus (HIV) has rarely been reported in the literature. In this report, we describe the ...experience of a single centre in the management of 10 such patients, including demographic information, disease characteristics and response to therapy. We had a black female predominance in our series, with only a minority of patients achieving a complete cytogenetic response. The main reason for this appears to be compliance, which was influenced by distance to the treating centre. The side-effect profile was similar to that expected, with the exception of one patient who developed a drug rash with eosinophilia and systemic symptoms. Although CML patients co-morbid for HIV face certain unique challenges when compared to non-infected patients, their long-term outcome can be positive when appropriately managed.
Abstract Education in transfusion medicine, aimed at clinical transfusion practice, is limited in most South African pre- and postgraduate medical training programs. A number of local and global ...factors impact on the need for and provision of transfusion medicine education programs in South Africa, which are discussed in this paper. A perspective is provided on the effects of issues such as global versus local training need, blood safety, appropriate use of blood in resource-restrained environments, the presence or absence of national blood policies, standardization of training, medical migration and workforce diversity. Harnessing support for the development of training programs for medical doctors and new opportunities for developing a career in transfusion medicine are discussed. Commentary is also provided on online learning, social networking and integration of modern paradigms of learning, such as screencasting and online learning, into teaching programs. This article should provide anyone in medical education or program development, in particular in the field of transfusion medicine, with an indication of the factors that should be considered when embarking on such an endeavor.
A conversation with colleagues on South African healthcare tends to quickly turn on each of our experiences and concerns about the challenges and uncertainties attached to it. Yet, all over the ...country examples of individuals standing up to innovate, make a change and work towards a better future for all, are becoming evident. Friday the 27th of September 2019 was no exception as a team of people came together, some old, some new, to explore how we can move our country forward in terms of Patient Blood Management. The concept of saving blood (and resources), while saving patient lives, has inspired a team of people from a range of specialty areas, as far apart as health economics to obstetrics, surgery, critical care, obstetrics, blood service, haematology and anaesthesiology, to mention only a few examples, to sit down and realty think how to advance Patient Blood Management (PBM) in South Africa, and move it from a nice idea to a practical solution. What made the origins of the practice of PBM in South Africa special, is that it did not originate in the ivory towers of academia (where some of us do spend most of our waking hours), but in a township hospital in rural KwaZulu-Natal, where Dr Rob Wise initiated what came to be known as the “Saving Blood, Saving Lives Project”. Following in his footsteps and in that of the teams working on PBM around the world, we got together on this lovely Friday in September to discuss how to go about this.
Abstract Background Quality education in transfusion medicine is key to delivering a safe and cost-effective blood service, yet postgraduate residency programs are lacking in many resource-limited ...countries and regions. The first formal, accredited, postgraduate training program in transfusion medicine aimed at medical doctors was developed and implemented at the University of the Free State in Bloemfontein, South Africa, in 2008. In the context of high demand and limited resources, ensuring sustainability of postgraduate training programs is essential. Study design and methods A formal qualitative and semi-quantitative research approach was followed to determine and test the factors considered important in program sustainability, and consisted of a literature survey, followed by semi-structured interviews and a Delphi survey. Results Fifty-five factors were identified from the semi-structured interviews. During the Delphi survey, consensus was reached on 41 and stability declared on a further 13. These factors formed the basis of a structured model informing the sustainability aspects of a postgraduate program in transfusion medicine. Conclusion Literature on program sustainability in the field of transfusion medicine is very limited. This study identified the key factors essential to the long-term viability of a postgraduate program in transfusion medicine and should find broad applicability in other resource-limited countries and regions. It is envisaged that this will enable such programs to reach a state of self-sufficiency while not being overly reliant on external funding and support.
The spectrum of sickle cell disease (SCD) encompasses a heterogeneous group of disorders that include: (I) homozygous SCD (HbSS), also referred to as sickle cell anaemia; (ii) heterozygous SCD ...(HbAS), also referred to as sickle cell trait; and (iii) compound heterozygous states such as HbSC disease, HbSβ thalassaemia, etc. Homozygous or compound heterozygous SCD patients manifest with clinical disease of varying severity that is influenced by biological and environmental factors, whereas subject with sickle cell trait are largely asymptomatic. SCD is characterized by vaso-occlusive episodes that result in tissue ischaemia and pain in the affected region. Repeated infarctive episodes cause organ damage and may eventually lead to organ failure. For effective management, regular follow-up with support from a multidisciplinary healthcare team is necessary. The chronic nature of the disease, the steady increase in patient numbers, and relapsing acute episodes have cost implications that are likely to impact on provincial and national health budgets. Limited resources mandate local management protocols for the purposes of consistency and standardisation, which could also facilitate sharing of resources between centres for maximal utility. These recommendations have been developed for the South African setting, and it is intended to update them regularly to meet new demands and challenges.
Plasma cell leukaemia (PCL) is a rare condition with high mortality. HIV-positive patients have a propensity to develop malignancy; however, the occurrence of PCL with HIV infection in South Africa ...has not been documented. We describe patients with PCL in Universitas Hospital in Bloemfontein, South Africa, and report two new cases of HIV infection concurrent with PCL. A retrospective case series of PCL patients (2006–2012) seen at our Clinical Haematology unit is reported. Patient files were used to obtain information. The median age of patients (
n
= 9) was 51 years, and 66.7 % of cases were of African ethnicity. The condition was equally distributed between genders. Two patients were HIV positive. Both received combination antiretroviral therapy. The diagnosis of PCL was usually made as an incidental finding, subsequently confirmed on bone marrow aspirate and trephine. Deranged haematological and biochemical parameters, including severe anaemia, hypoalbuminaemia, and hyper-cellular bone marrow, were observed. Only one patient improved markedly on treatment, and remains alive at the time of writing. PCL shows poor response to treatment and predominates among Africans. The small sample size made it difficult to determine whether co-infection with HIV was a coincidental finding or the two diseases are pathophysiologically linked.
Abstract Hyperleukocytosis is a rare but potentially serious complication of haematological malignancies. It is usually treated with rehydration, prevention of tumour lysis syndrome and the ...administration of cytotoxic therapy. Leukapheresis may be life-saving in emergency cases. In this article we describe how, in a resource-limited setting where leukapheresis was not available, manual exchange transfusion was utilised as a life-saving intervention in three patients with different haematological malignancies complicated by hyperleukocytosis. Further we outline the procedure that was carried out and evaluated possible complications associated with this rarely used practice.
To the Editor:
In the last sentence of their review article, Harousseau and Moreau (June 18 issue)
1
state that the patient they describe had no adverse prognostic factors. However, the patient ...actually had three such adverse factors: a deletion of chromosome 13, a β
2
-microglobulin level of 2.8 mg per liter, and a hemoglobin level of 9.8 g per deciliter.
2
In a study of 110 patients undergoing autologous stem-cell transplantation for myeloma, the two most powerful adverse prognostic factors were a monosomy or deletion of chromosome 13 and a serum β
2
-microglobulin level of more than 2.5 mg . . .
Blood transfusions come with risks and high costs, and should be utilized only when clinically indicated. Decisions to transfuse are however not always well informed, and lack of clinician knowledge ...and education on good clinical transfusion practices contribute to the inappropriate use of blood. Low and middle-income countries in particular take much strain in their efforts to address blood safety challenges, demand-supply imbalances, high blood costs as well as high disease burdens, all of which impact blood usage and blood collections. Patient blood management (PBM), which is a patient-focused approach aimed at improving patient outcomes by preemptively diagnosing and correcting anaemia and limiting blood loss by cell salvage, coagulation optimization and other measures, has become a major approach to addressing many of the challenges mentioned. The associated decrease in the use of blood and blood products may be perceived as being in competition with blood conservation measures, which is the more traditional, but primarily product-focused approach. In this article, we hope to convey the message that PBM and blood conservation should not be seen as competing concepts, but rather complimentary strategies with the common goal of improving patient care. This offers opportunity to improve the culture of transfusion practices with relief to blood establishments and clinical services, not only in South Africa and LMICs, but everywhere. With the COVID-19 pandemic impacting blood supplies worldwide, this is an ideal time to call for educational interventions and awareness as an active strategy to improve transfusion practices, immediately and beyond.
The Publisher regrets that this article is an accidental duplication of an article that has already been published, 10.1016/j.transci.2013.09.003. The duplicate article has therefore been withdrawn.
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