TY - JOUR A1 - Schossee, Nadine A1 - Veit, Gabriele A1 - Gittel, Julia A1 - Viebahn, Johannes A1 - Niklaus, Marius A1 - Klingler, Philipp A1 - Üçeyler, Nurcan A1 - Klinker, Erdwine A1 - Kobsar, Anna A1 - Boeck, Markus A1 - Koessler, Juergen T1 - Profile of the single-use, multiple-pass protein A adsorber column in immunoadsorption JF - Vox Sanguinis N2 - Background and Objectives Immunoadsorptions (IA) are used to remove autoantibodies from the plasma in autoimmune disorders. In this study, we evaluated the effects of a single-use, recombinant staphylococcal protein A-based immunoadsorber on blood composition of the patient. Materials and Methods In a cohort of patients with myasthenia gravis or stiff-person syndrome, essential parameters of blood cell count, coagulation, clinical chemistry or plasma proteins and immunoglobulins (Ig) were measured before and after IA (n = 11). Results In average, IA reduced the levels of total IgG, IgG1, IgG2 and IgG4 by approximately 60%, the acetylcholine receptor autoantibody levels by more than 70%. IgG3, IgA or IgM were diminished to a lower extent. In contrast to fibrinogen or other coagulation factors, the column markedly removed vitamin K-dependent coagulation factors II, VII, IX and X by approximately 40%–70%. Accordingly, international normalized ratio and activated partial thromboplastin time were increased after IA by 59.1% and 32.7%, respectively. Coagulation tests almost returned to baseline values within 24 h. Blood cell count, electrolytes, total protein or albumin were not essentially affected. No clinical events occurred. Conclusion The single-use, multiple-pass protein A adsorber column is highly efficient to remove IgG1, IgG2 and IgG4 or specific acetylcholine receptor autoantibodies from the plasma. Coagulation parameters should be monitored, since the column has the capacity to largely reduce vitamin K-dependent factors. KW - plasma KW - apheresis technologies KW - apheresis-therapeutic KW - blood processing KW - haemostasis Y1 - 2022 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-259689 VL - 117 IS - 3 ER - TY - JOUR A1 - Meybohm, Patrick A1 - Straub, Niels A1 - Füllenbach, Christoph A1 - Judd, Leonie A1 - Kleinerüschkamp, Adina A1 - Taeuber, Isabel A1 - Zacharowski, Kai A1 - Choorapoikayil, Suma T1 - Health economics of Patient Blood Management: a cost‐benefit analysis based on a meta‐analysis JF - Vox Sanguinis N2 - Background and Objectives Patient Blood Management (PBM) is the timely application of evidence‐based medical and surgical concepts designed to improve haemoglobin concentration, optimize haemostasis and minimize blood loss in an effort to improve patient outcomes. The focus of this cost‐benefit analysis is to analyse the economic benefit of widespread implementation of a multimodal PBM programme. Materials and Methods Based on a recent meta‐analysis including 17 studies (>235 000 patients) comparing PBM with control care and data from the University Hospital Frankfurt, a cost‐benefit analysis was performed. Outcome data were red blood cell (RBC) transfusion rate, number of transfused RBC units, and length of hospital stay (LOS). Costs were considered for the following three PBM interventions as examples: anaemia management including therapy of iron deficiency, use of cell salvage and tranexamic acid. For sensitivity analysis, a Monte Carlo simulation was performed. Results Iron supplementation was applied in 3·1%, cell salvage in 65% and tranexamic acid in 89% of the PBM patients. In total, applying these three PBM interventions costs €129·04 per patient. However, PBM was associated with a reduction in transfusion rate, transfused RBC units per patient, and LOS which yielded to mean savings of €150·64 per patient. Thus, the overall benefit of PBM implementation was €21·60 per patient. In the Monte Carlo simulation, the cost savings on the outcome side exceeded the PBM costs in approximately 2/3 of all repetitions and the total benefit was €1 878 000 in 100·000 simulated patients. Conclusion Resources to implement a multimodal PBM concept optimizing patient care and safety can be cost‐effectively. KW - Patient Blood Management (PBM) KW - haemoglobin concentration KW - haemostasis KW - blood loss Y1 - 2020 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-214084 VL - 115 IS - 2 SP - 182 EP - 188 ER - TY - RPRT ED - Nieswandt, Bernhard T1 - Platelets – Molecular, cellular and systemic functions in health and disease T1 - Thrombozyten – molekulare, zelluläre und systemische Funktionen unter physiologischen und pathologischen Bedingungen (SFB/TR240 - Abschlussbericht BT - Final Report (2018/2 - 2023/1) N2 - Besides their central role in haemostasis and thrombosis, platelets are increasingly recognised as versatile effector cells in inflammation, the innate and adaptive immune response, extracellular matrix reorganisation and fibrosis, maintenance of barrier and organ integrity, and host response to pathogens. These platelet functions, referred to as thrombo-inflammation and immunothrombosis, have gained major attention in the COVID-19 pandemic, where patients develop an inflammatory disease state with severe and life-threatening thromboembolic complications. In the CRC/TR 240, a highly interdisciplinary team of basic, translational and clinical scientists explored these emerging roles of platelets with the aim to develop novel treatment concepts for cardiovascular disorders and beyond. We have i) unravelled mechanisms leading to life-threatening thromboembolic complica-tions following vaccination against SARS-CoV-2 with adenoviral vector-based vaccines, ii) identified unrecognised functions of platelet receptors and their regulation, offering new potential targets for pharmacological intervention and iii) developed new methodology to study the biology of megakar-yocytes (MKs), the precursor cells of platelets in the bone marrow, which lay the foundation for the modulation of platelet biogenesis and function. The projects of the CRC/TR 240 built on the unique expertise of our research network and focussed on the following complementary fields: (A) Cell bi-ology of megakaryocytes and platelets and (B) Platelets as regulators and effectors in disease. To achieve this aim, we followed a comprehensive approach starting out from in vitro systems and animal models to clinical research with large prospective patient cohorts and data-/biobanking. Despite the comparably short funding period the CRC/TR 240 discovered basic new mechanisms of platelet biogenesis, signal transduction and effector function and identified potential MK/platelet-specific molecular targets for diagnosis and therapy of thrombotic, haemorrhagic and thrombo-inflammatory disease states. N2 - Thrombozyten sind von zentraler Bedeutung für die Hämostase, aber auch bei der Entstehung akuter thrombotischer Erkrankungen wie Herzinfarkt oder Schlaganfall. Darüber hinaus sind Thrombozyten aber auch vielseitige Effektorzellen von Entzündungsprozessen, der angeborenen Immunität, bei zellulären Abwehrmechanismen sowie bei der Aufrechterhaltung der Gefäß- und Organintegrität. Diese neuen, als Thrombo-Inflammation und Immunothrombose bezeichneten Funktionen haben im Rahmen der COVID-19 Pandemie große Aufmerksamkeit erlangt, da betroffene Patienten systemische Entzündungszustände in Verbindung mit thromboembolischen Komplikationen aufweisen, die oft auch tödlich verlaufen. Im SFB/TR 240 arbeitete ein interdisziplinäres Team von grundlagenorientierten, translationalen und klinischen Wissenschaftlern zusammen an der Erforschung dieser neuartigen Thrombozytenfunktionen mit dem Ziel, neue verbesserte Therapiemöglichkeiten für kardiovaskuläre, aber auch andere Erkrankungen zu entwickeln. Während der Förderphase haben wir i) die Mechanismen aufgeklärt, die in seltenen Fällen nach Impfung mit Adenovirus-basierten Vakzinen gegen Sars-CoV-2 zu lebensbedrohlichen thromboembolischen Komplikationen führten, ii) neue Funktionen und Regulationsmechanismen thrombozytärer Rezeptoren identifiziert, die Grundlage zur therapeutischen Intervention sein könnten und iii) neue Technologien entwickelt, die vertiefte Studien zur Biologie der Megakaryozyten, den Vorläuferzellen der Thrombozyten im Knochenmark, ermöglichen und den Weg zu einer gezielten Beeinflussung der Thrombozytenbiogenese und –funktion ebnen könnten. Die Projekte des TR 240 konzentrierten sich auf die folgenden komplementären Forschungsgebiete: (A) Zellbiologie der Megakaryozyten und Thrombozyten mit dem Ziel eines verbesserten Verständnisses der grundlegenden Funktionen beider Zelltypen und (B) Thrombozyten als Modulatoren und Effektoren bei Erkrankungen. Um dieses Ziel zu erreichen, wurde ein sehr umfassender Ansatz verfolgt, der sich von in vitro Systemen über Tiermodelle bis hin zur klinischen Forschung mit Biobanken und großen, prospektiven Patientenkohorten erstreckte. Der SFB/TR 240 konnte in der vergleichsweisen kurzen Zeit seiner Förderung grundlegend neue Erkenntnisse zu den Mechanismen der Thrombozytenbiogenese, Thrombozyten-Signaltransduktion und -Effektorfunktionen erarbeiten und neue MK/Thrombozyten-spezifische Angriffspunkte für Diag-nose und Therapie thrombotischer, hämorrhagischer und thrombo-inflammatorischer Erkrankungen identifizieren. KW - Thrombozyt KW - platelets KW - thrombo-inflammation KW - haemostasis KW - stroke KW - megakaryocytes KW - Sonderforschungsbereich Transregio 240 KW - Bericht KW - Collaborative Research Center KW - Experimental Biomedicine Y1 - 2024 U6 - http://nbn-resolving.de/urn/resolver.pl?urn:nbn:de:bvb:20-opus-359636 ER -