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Serologic Characteristics and Clinical Significance of Non-ABO Red Blood Cell Antibodies in Hematopoietic Stem Cell Transplant. The BEST Collaborative Study
No full textBACKGROUND: ABO-incompatible hematopoietic stem cell transplant (HSCT) has a number of well-established complications including hemolysis, delayed RBC engraftment, pure red cell aplasia (PRCA), and transfusion dependence. However, the clinical significance of non-ABO RBC antibodies in allogeneic HSCT remains insufficiently explored.
OBJECTIVE: The aim of this study is to characterize the prevalence, incidence, and clinical implications of non-ABO RBC auto- and alloantibodies in the HSCT population.
STUDY DESIGN: This international, multicenter, retrospective study analyzed HSCT 2010-2021 across nine U.S. and one Brazilian academic centers. This study focused on immunohematologic findings in recipients of allogeneic HSCTs, excluding hemoglobinopathies. RBC antibodies were evaluated pre-HSCT and 100 days post-HSCT. Hemolysis was assessed by labs and confirmed by a two-physician review of the medical records. Descriptive statistics and regression analysis were performed. IRB approval and data use agreements were obtained at each center.
RESULT: Study analysis included a total of 8896 transplants. The majority of transplants utilized apheresis collections (78.0%), were matched unrelated (41.6%), involved a non-myeloablative conditioning regimen (51.2%), and were ABO-compatible (56.7%). The prevalence of non-ABO antibodies pre-HSCT, including auto-, alloantibodies, and passive transfer of anti-D, was 4.0% (n=355). The majority of these were alloantibodies (77.5%), followed by warm autoantibodies (7.3%) and both alloantibodies and warm-reactive autoantibodies (6.5%). De-novo antibody formation post-HSCT occurred in 1.5% (n=135). The most frequent pre-HSCT alloantibody specificities were in the Rh blood group system (46%), followed by Kell (17%) and Kidd (13%). The incidence of anti-D in RhD-mismatched transplant was 1% (n=8) for RhD-positive recipients with RhD-negative donors, and 0.2% (n=2) for RhD-negative recipients with RhD-positive donors. Myeloproliferative neoplasms and myelodysplastic syndromes had the highest rate of antibodies pre- and post-HSCT. Hemolysis was observed in 24 cases (antibodies present pre-HSCT) and 15 de-novo cases post-HSCT. Pure red cell aplasia was not observed in any of these cases. The presence of non-ABO RBC antibodies was associated with higher RBC transfusions, but not platelet transfusions; engraftment of neutrophils and platelets were not affected by the presence of RBC antibodies.
CONCLUSION: The current study reports on a low prevalence of RBC antibodies, including allo- and autoantibodies, in HSCT patients during the peri-transplant period, with a rate of 4% for those with pre-existing antibodies prior to transplant and 1% for the de-novo antibody formation post-transplant. They are associated with a low risk of mild to moderate hemolysis, but increased RBC transfusions. Comprehensive immunohematology data should be incorporated into HSCT databases for improved risk assessment, monitoring, and management
A little nudge goes a long way: assessing the impact of a microbiology nudge comment on narrow-spectrum antibiotic use in uncomplicated Streptococcus pneumoniae bloodstream infections
No full textNarrow-spectrum antibiotic prescribing (ampicillin IV or penicillin IV) was compared before and after implementing an interpretive microbiology comment for uncomplicated Streptococcus pneumoniae bloodstream infections. The postintervention group was associated with 4-fold increased odds of de-escalation to narrow-spectrum antibiotics (adjusted odds ratio, 4.66; 95% confidence interval, 1.97-11.00)
Interventions influencing patient-reported outcomes (PROs) response rates in cancer: a scoping review
No full textPURPOSE: Despite the emerging evidence around patient-reported outcome measures (PROMs) monitoring benefits in oncology, completion rates remain low due to numerous multi-level barriers. This review summarizes existing literature on interventions employed to improve PROMs response rates in routine practice among patients with cancer.
METHODS: PubMed database was used to perform a literature search of articles published between 2000 and 2022. Articles were included if they focused on PROMs implementation in non-clinical trial setting and reported results on methodologies and their influence on response rates.
RESULTS: A total of 495 abstracts were screened for eligibility, and 14 articles that met the inclusion criteria were included. PROMs mode of administration varied between electronic only (four studies, 28.6%), paper only (two studies, 14.3%), electronic-paper (six studies, 42.9%), and electronic-telephone (two studies, 14.3%). Reminder systems, using electronic, paper, or in-person, were implemented in 12 studies (85.7%). Different strategies of initial recruitment, aiming to enhance patients\u27 PROM engagements, were outlined in five studies (35.7%).
CONCLUSION: Multiple interventions were implemented to improve PROMs completion rates. Mode of questionnaire administration, reminder systems, patient education on benefits of PROMs, and clinical staff involvement were shown to be effective in increasing the overall completion rate.
IMPLICATIONS FOR CANCER SURVIVORS: This review provides a summary for researchers and clinicians on the current practice of PROMs implementation, thus creating a framework for the impact of different methodologies on patient\u27s response rate for better monitoring of recurring symptoms, including long-term side effects, emotional distress, and changes in health-related quality of life
Sleep and circadian rhythms in cardiovascular resilience: mechanisms, implications, and a Roadmap for research and interventions
No full textThe interaction between sleep, circadian rhythms and cardiovascular resilience is a crucial yet underexplored research area with important public health implications. Disruptions in sleep and circadian rhythms exacerbate hypertension, diabetes mellitus and obesity, conditions that are increasingly prevalent globally and increase the risk of cardiovascular disease. A National Heart, Lung, and Blood Institute workshop examined these connections, as well as the emerging concept of cardiovascular resilience as a dynamic and multifaceted concept spanning molecular, cellular and systemic levels across an individual\u27s lifespan. The workshop emphasized the need to expand the focus from solely understanding whether and how sleep and circadian rhythm disturbances contribute to disease, to also exploring how healthy sleep and aligned circadian rhythms can increase cardiovascular resilience. To develop a Roadmap towards this goal, workshop participants identified key knowledge gaps and research opportunities, including the need to integrate biological, behavioural, environmental and societal factors in sleep and circadian health with cardiovascular research to identify therapeutic targets. Proposed interventions encompass behavioural therapies, chronotherapy, lifestyle changes, organizational policies and public health initiatives aimed at improving sleep and circadian health for better cardiovascular outcomes. Future cross-disciplinary research and translation of discoveries into public health strategies and clinical practices could improve cardiovascular resilience across the lifespan in all populations
Limb salvage using Pounce LP mechanical thrombectomy system after failed open and percutaneous thromboembolectomy
No full textMechanical thrombectomy devices have limited efficacy in organized subacute and chronic thrombi and face challenges in small-caliber distal vessels. The Pounce LP Thrombectomy System (Surmodics) is a fully percutaneous, purely mechanical thrombectomy device designed to overcome these limitations. We report the case of an 83-year-old female presenting to an out-of-state hospital with acute limb ischemia secondary to a right external iliac artery occlusion. Despite percutaneous mechanical thrombectomy with an aspiration thrombectomy device and subsequent open Fogarty balloon thromboembolectomy for distal embolization, her ischemia worsened, and a below-knee amputation was recommended. Upon transfer to our institution, she had sensorimotor deficits, distal ischemic changes, and occlusions of the anterior tibial, posterior tibial, and peroneal arteries at the level of the midcalf. Mechanical thrombectomy using the Pounce LP device successfully removed organized thrombus and restored multiphasic inline flow to the peroneal artery and its communicating branch, which subsequently fed into the distal posterior tibial artery and the plantar vessels. The patient ultimately underwent a successful transmetatarsal amputation, achieving limb salvage
Association of Maternal Prepregnancy BMI With Offspring Cardiometabolic Outcomes in Childhood
No full textOBJECTIVE: This study aimed to evaluate associations of maternal prepregnancy BMI with offspring BMI and blood pressure in childhood, specifically for infants born preterm.
METHODS: In this observational cohort study of children in the Environmental Influences on Child Health Outcomes (ECHO) Cohort, we utilized four levels of maternal prepregnancy BMI and child BMI. Children were categorized as being born extremely, very, or moderately preterm; late preterm; or term.
RESULTS: In total, 13,810 children from 44 ECHO cohorts were included in these analyses. After adjusting for maternal education, maternal age at delivery, and singleton birth, a monotonic dose relationship was noted between child BMI z-scores and maternal prepregnancy BMI level. For child blood pressure outcomes, only extremely preterm children born to mothers with healthy weight and obesity and very/moderately preterm children born to mothers with healthy weight had higher odds of elevated blood pressure/hypertension compared with their term counterparts.
CONCLUSIONS: High maternal prepregnancy BMI was associated with a stepwise increase in offspring BMI in childhood. Preterm children had a higher probability of elevated blood pressure/hypertension than term children. These findings highlight a possible window of opportunity to modify lifestyles and behavior of at-risk children prior to adolescence to positively impact adolescent cardiometabolic health
Cut to the Heart: Emergency Sternotomy Training
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1006/thumbnail.jp
Increasing Comfort and Support in the New Graduate Nurse Through Focused Curriculum Delivery
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1018/thumbnail.jp
Multidisciplinary Accountability in Fall Prevention
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1024/thumbnail.jp
Virtual Registered Nurse: Journey to Improved Outcomes and Increased Patient Satisfaction
No full texthttps://scholarlycommons.henryford.com/nursresconf2025/1035/thumbnail.jp