bluuebunny/crossref_metadata_2025_split huggingface dataset:
PB2257 USE OF ARGATROBAN AS AN ANTICOAGULANT TREATMENT ALTERNATIVE IN CRITICAL PATIENTS WITH HEPARIN‐INDUCED THROMBOCYTOPENIA. EXPERIENCE IN A THIRD LEVEL HOSPITAL.
Authors: Salvador E. , Villalba M. , García A. , Pinzón S. , Fernández N. , Calvo J. M. , Delgado P. 
Published: June 2019

Background:Heparin is a widely used drug. The most frequent complication derived from its use is the haemorrhage. However, an uncommon but potentially serious adverse effect is heparin‐induced thrombocytopenia (HIT). The goal of treatment of HIT is to reduce platelet activation and thrombin formation to decrease the risk of thrombosis. Argatroban is the drug of choice in HIT patients as an alternative anticoagulant treatment in critically ill patients with high risk of haemorrhage, postoperative cardiac events or renal failure, since it allows close control of anticoagulation.Aims:To analyze the clinical, laboratory and therapeutic characteristics of patients treated with Argatroban by HIT in our hospitalMethods:Retrospective analysis or patients treated with Argatroban for diagnosed HIT during the last year.Results:Four patients have required treatment with Argatroban for HIT since they required maintenance of anticoagulation due to mitral prosthesis, unstable angina, DVT in the right lower extremity and acute ischemia in the left lower extremity. Median age 68 years (43‐79). All of them were diagnosed with HIT according to the 4T score during their admission to the Intensive Care Unit. PF4/Heparin antibody testing was positive in the four patients.The median number of days from the start of Heparin treatment (2 with unfractioned and 2 with low molecular weight) to the onset of thrombocytopenia was 6 days (1‐8). Median platelets at diagnosis were 73x109/L (49‐82). Median number of days from the start of Argatroban to platelet recovery was 6 days (3‐12). Median number of days of treatment with Argatroban was 9.5 days (2‐18). Argatroban dose was adjusted to maintain aPTT at 1.5‐3.0 times baseline. 3 patients presented thrombotic events, 2 directly related to HIT (1 ischemic stroke and 1 acute ischemia of right upper extremity) and 1 with worsening of reperfusion of the limb. 2 patients required amputation of the limb. No adverse events associated with Argatroban, including haemorrhage, were observed.Summary/Conclusion:HIT is a potentially catastrophic complication of heparin treatment which requires urgent detection and treatment with a non‐heparin anticoagulant such as Argatroban should be initiated. Even in critically ill patients, Argatroban anticoagulation improves clinical outcomes in patients who have HIT, without increasing bleeding risk.
PB2258 ERYTHROPOIESIS STIMULATING AGENTS (ESAS) IN MANAGEMENT OF MYELODYSPLASTIC SYNDROMES: RECAMDS TRIAL
Authors: Cerchione C. , Martinelli G. , Soriente I. , D’Arco A. M. , Danise P. , Cerciello G. , Pane F. , Alfinito F. 
Published: June 2019

Background:Erythropoiesis stimulating agents (ESAs) are the frontline treatment in low‐risk anemic MDS patients and an employment of this therapy in the earlier stage of the disease can delay the need for RBC transfusion, hypothetically by slowing the disease course. It's matter of debate whether the clinical response is a result of proliferation and maturation of the dysplastic clone or stimulation of residual normal erythropoiesis by ESAs.Aims:Macrocytosis is one of the cytological hallmarks of dyserithropoiesis in MDS: an analysis of the erythropoietic response to ESAs therapy in a cohort of anemic non trasfusion‐dependent MDS patients, enrolled in a retrospective register, RECAMDS, subgroup of Italian register, was performed.Methods:183 patients, treated with standard‐dose ESAs, have been retrospectively analyzed (Table 1). Data analysis was performed, according to IWG 2006 criteria, at the baseline, after 3 and 6 months of continuous treatment, with a subanalysis of the patients according to WHO and R‐IPSS risk stratification. ESAs were started at mean Hb concentration of 9.31 g/dl, mean serum EPO concentration: 51 mU/L, after a mean time from diagnosis of 6 months (r.1‐118).Results:Overall response rate (ORR) was 83.6% (153/183), no difference among WHO and IPSS subgroups was found: 132/183 (72.1%) achieved response after 3 months of treatment, while other 21/183 (11.2%) after 6 months. 19 patients with stable disease (non‐responders, according to IWG criteria), in which treatment was continued, achieved response after 9 months. In the macrocytic‐responders group 83.2% exhibits again macrocytosis after 3 months, while 16.8% become normocytic. In the normocytic‐responders group 89.8% exhibits again normocytosis, while 10.2% become macrocytic: in these patients, after 3 months, there was a contemporary worsening in neutropenia and thrombocytopenia, with transfusion‐dependence, regarded as first signs of progression of disease. Non‐responders were 30/183 (16.3%): in the macrocytic non‐responders group 89% exhibit again macrocytosis after 3 months, while 11% become normocytic; in the normocytic group 76% exhibits again macrocytosis, while 24% become normocytic.Summary/Conclusion:These preliminary data can suggest that, in the majority of MDS patients responsive to ESAs, the increase of Hb concentration occurs mainly stimulating erythroid production in MDS clones; in the minority of patients probably it happens recruiting residual polyclonal erythropoiesis.It is interesting to note that stimulating effects of ESAs last even when the expression of dysplasia progresses.
PB2271 POMALIDOMIDE‐DEXAMETHASONE IN THE MANAGEMENT OF HEAVILY PRETREATED MULTIPLE MYELOMA
Authors: Cerchione C. , Martinelli G. , Nappi D. , Pareto A. E. , Di Perna M. , Ferrara K. , Ferrari A. , Simonetti G. , Pane F. , Catalano L. 
Published: June 2019

Background:Pomalidomide is a new generation IMID, with a very good compliance, thanks to oral administration, which can be used also in heavily pretreated patients, in a domestic setting.Aims:In this retrospective observational trial, It has been evaluated efficacy and tolerance of pomalidomide plus dexamethasone (PD) as salvage regimen in heavily pretreated patients with relapsed and refractory MM (rrMM), whose prognosis is particularly severe.Methods:33 patients (19 M/14 F), with rrMM, median age at diagnosis 69 years (r. 52‐84), and median age at start of treatment 76 years (r.56‐89) treated with several lines of treatments (median 7, r. 2‐11), every refractory to all the drugs previously received (also Bortezomib, Thalidomide and Lenalidomide), received Pomalidomide‐Dexamethasone (Pomalidomide 4 mg for 21 days, Dexamethasone 40 mg days 1,8,15,22, pegfilgrastim day +8) every 28 days, until progression. ISS was equally distributed, and cytogenetic at relapse was evaluable in 14 patients. All the patients had previously been treated with schedule containing bortezomib and IMIDs. 60% (20/33) of them had undergone at least to a single ASCT. All patients were relapsed and refractory to last therapies received before PD.Results:Pomalidomide was well tolerated, with grade 3 anemia in 51% (17/33) of patients, 36.3% (12/33) grade 3 neutropenia (pegfilgrastim in primary prophylaxis was given, no hospitalization was required, no septic shocks were observed), 30.3% (10/33) grade 3‐4 thrombocytopenia without hemorrhagic events and transfusion‐dependence. No severe extra‐hematologic toxicity was observed. According to IMWG, ORR1 (≥PR) was 45.4% (15/33: 4 CR, 5 VGPR, 6 PR), but, considering that we are evaluating a cohort of heavily pretreated patients, with poor prognosis, another parameter should be considered, ORR2 (≥SD), considering stable disease as a successful result in progressive MM. ORR2 was 78.7% (26/33: 4 CR, 5 VGPR, 6 PR, 11 SD). These can be considered as impressive result in this subset of patients. Oral treatment gives a really good compliance, in frail and unfit patients, and response, when present, is always really fast (median time to response: 2 months (r.1‐6)), median OS from diagnosis was 92 months (range 21‐234), median OS from start of pomalidomide was 9 months (range 1‐25).Summary/Conclusion:Pomalidomide‐dexamethasone has shown significant efficacy and a very good compliance, thanks to oral administration, in a particularly severe setting of heavily pretreated patients, relapsed and refractory to all available therapeutic resources.
PB2279 EFFECT OF EDUCATIONAL TRAINING PROGRAM ON IMPROVING PEDIATRIC ONCOLOGY NURSES, PRACTICE REGARDING NON PHARMACOLOGICAL PAIN MANAGEMENT
Authors: Hesham M. , Dakhakhny A. El‐ , Ramadan R. , besheer M. 
Published: June 2019

Background:Pain in cancer children poses a significant challenge for health professionals. It is most often not adequately treated because of inexperience and unfounded fears of analgesic treatment. Non pharmacological interventions support patients in coping with the disease consequences and in playing an active role in the management of their condition. Nurses are the professionals most responsible for caring for patient's pain and play a critical role in efficient pain management.Aims:to identify the effect of an educational training program on improvement of pediatric oncology nurses’ practice regarding non‐ pharmacological pain management.Methods:A quasi‐experimental study design was conducted on a sample of 23 nurses who were working in in Pediatric Hematology and Oncology unit at Zagazig university children hospitals. Two tools were used in the present study at three phases (pretest, post‐test and follow up after 2 months); first: a questionnaire interview sheet to assess nurses’ knowledge related to pain and non‐ pharmacological pain management, the second: a structured observational checklist for nurses’ practice.Educational training program was developed to train pediatric oncology nurses about non‐pharmacological pain management in children (Massage technique,Reflexology massage,Hotand cold Pack Application,Slow rhythmic breathing).Results:from the present study we revealed that none of the studied nurses had good knowledge score before implementation of the program. This percentage increased to 100.0% after implementation of the program and decreased to 52.2% at follow up phases of the program. Pediatric oncology nurses practice had been improved significantly after implementation of the educational training program either immediately or 2 months later.Summary/Conclusion:it was concluded that educational training program to pediatric oncology nurses had improved their knowledge and practice regarding non pharmacological pain management as there was a statistical significant difference throughout the three phases of the study. Based on the results of the present study continuous formal training programs for updating the knowledge and practice of pediatric oncology nurses about non‐pharmacological pain management was recommended.
PB2292 ROLE OF SMOKING ON HEMATOLOGICAL PARAMETERS AND FERRITIN LEVELS
Authors: Çiftçiler R. , Guven A. , Haznedaroglu I. , Aksu S. 
Published: June 2019

Background:Cigarette smoking is associated with an increased risk of cardiovascular diseases, including coronary artery disease, peripheral vascular disease, ischemic heart disease, atherosclerosis, myocardial infarction and stroke. Our aim was to define possible effects of smoking on hematological parameters as well as ferritin and transferrin saturation.Aims:In this study, we evaluated the association between hematological parameters and smoking status. Our aim was to define the possible effects of smoking on hematological parameters as well as ferritin and transferrin saturation.Methods:This study has been performed in a retrospective manner. One hundred and forty nine patients who admitted to Hacettepe University Hospitals between September 2018 and November 2018 were evaluated. Inclusion criterion in this study were ≥ being older than 18 years of age, having no chronic diseases such as diabetes mellitus, ischemic heart disease, peripheral vascular disease, active liver and kidney disease, chronic pancreatitis, gastrointestinal disease, inflammatory bowel diseases, hypertension, any infectious or debilitating illness. In addition, patients who were on medications such as antibiotics, steroids, thiazide diuretics, aspirin, non‐steroidal anti‐inflammatory drugs, immunomodulatory drugs and drugs that may interfere with ferritin and CBC parameters were excluded from the study.Results:There were 95(63.7%) healthy non‐smokers and 54 (36.3%) healthy smokers included in this study. The median age was 32 (18‐61) years for all groups. There were 47 (31.5%) males and 102 (68.5%) females in this study. Hemoglobin (p<0.001), HCT (p<0.001) and MCV (p = 0.002) were statistically significantly higher in smokers group than in non‐smokers group. Leukocyte (p<0.001), neutrophil (p = 0.001) and lymphocyte (p = 0.04) counts were statistically significantly higher in smokers group compared to non‐smokers group.Summary/Conclusion:In conclusion, our study showed that cigarette smoking has severe adverse effects on hematological parameters such as hemoglobin, leucocytes, lymphocytes, MCV and HCT. These alterations might be associated with a greater risk of developing secondary polycythemia, atherosclerosis, chronic obstructive pulmonary disease and cardiovascular diseases.image
PB2299 AN INVESTIGATION INTO THE PRESENCE OF COMPLEMENT PROTEINS ON ERYTHROCYTE VESICLES IN SICKLE CELL DISEASE
Authors: Obieze C. 
Published: June 2019

Background:A single amino acid substitution in the globin gene segment is the underlying genetic defect in sickle cell disease (SCD) creating a haemoglobin molecule which polymerizes on deoxygenation. Recent insights into the pathophysiology of the disease have pointed to the roles inflammation and hypercoagulability play in disease manifestation and severity caused, in part, by increased phosphatidylserine exposure and extracellular vesiculation by sickle red cells.Current works have identified some of these vesicles as those released from reticulocytes in the process of maturation to the red blood cell. These vesicles are termed ‘inside‐out’ autophagic vesicles as they are the result of the fusion of endocytosed parts of the cell membrane with autophagic endosomes and are positive for intracellular glycophorin A (GPA) epitope using BRIC163 antibody. Further analysis has shown that some of these vesicles are also positive for extracellular GPA epitope using BRIC256 antibody raising the possibility that the vesicle membrane may have become permeabilized. One possible permeabilizing mechanism is the membrane attack complex of the complement system.Aims:The aim of this project was to investigate the presence of complement proteins on vesicles isolated from plasma or attached to erythrocytes using flow cytometry and confocal microscopyMethods:Vesicles were isolated from SCD plasma (n = 2) and healthy control (n = 1) using 2 different techniques: membrane‐based isolation technique and fluorescent‐activated cell sorter (FACS) and studied with flow cytometry using BRIC163, BRIC256, C3, C4, C3c and C3d antibodies. Cultured reticulocyte (n = 2), sickle red cells (n = 3) and healthy control red cells (n = 2) were analyzed with confocal microscopy using Annexin‐V, BRIC163, C3, C4, C3c and C3d antibodies.Results:Results show the presence of complement proteins on vesicles in both SCD plasma and healthy control in levels as high as 100% for BRIC163 vesicles in healthy control. Confocal analyses reveal this deposition is also present on vesicles prior to release and is associated with PS exposure.Summary/Conclusion:Complement proteins are present on vesicles in plasma and erythrocytes and may suggest activation and formation of the MAC complex. Further work is required to determine the involvement of these proteins in vesicle formation and release.
PB2308 THE EFFECT OF SICKLE CELL DISEASE ON PREGNANCY IN AL‐AHSA, KSA 2012‐2017
Authors: Abdulrahman S. , Alsaleh E. , Algadeeb S. , Algadeeb J. , Algadeeb M. , algadeeb R. 
Published: June 2019

Background:Pregnant women with SCD are at an increased risk for maternal and fetal morbidity and mortality (1,2). The numerous potential maternal complications include anaemia, acute crisis, preeclampsia, eclampsia, urinary tract infection, pneumonia, and acute chest syndrome (3,4,5,6). In addition, Pregnant women with SCD had lower maternal weight and gestational weight gain (7,8).Aims:The aim of this study was to compare the pregnancy outcomes between pregnant women with Sickle Cell Disease and pregnant women without Sickle Cell Disease and to measure the difference in weight gain between two groups.Methods:A quantitative retrospective cohort study carried out between January 2012 and December 2017 in Maternal and Children Hospital and Primary Health Care centres in Al‐Ahsa, an eastern region of the Kingdom of Saudi Arabia (KSA). The study population included all SCD patients who were registered for antenatal care follow up in the MCH and, on the other side, pregnant women without SCD from the primary health care centres depending on inclusion and exclusion criteria. The total sample size was 429. One hundred forty‐three pregnant women with Sickle Cell at the Maternity and Children Hospital and 286 pregnant non‐Sickle Cell from PHCCs were recruited by matching in residency. The data collection sheet used to gather patient information was prepared based on the card of antenatal care in the Ministry of Health and literature review.Results:Weight, BMI, and haemoglobin level at the first antenatal visit showed a significant difference between the two groups (P < 0.001). Forty‐three present of women with SCD had cesarean sections, compared to 13.9% of women without SCD, and there was a statistically significant association between them (P < 0.001). Maternal weight gain was lower in women with Sickle Cell Disease and showed statistically significant (P < 0.001). Women with Sickle Cell Disease had an increased risk of Caesarean section (AOR = 3.807, 95%CI = 2.074‐6.987, P < 0.001).Summary/Conclusion:Women with Sickle Cell Disease are more likely to have adverse pregnancy outcomes compared to women without Sickle Cell Disease. Women with Sickle Cell Disease had lower weight gain during pregnancy.
PB2312 PANORAMA OF HEMOGLOBINOPATHIES IN THE ANNABA REGION OF ALGERIA
Authors: Djenouni A. , GRIFI F. 
Published: June 2019

Background:Various national studies and some multicenter studies have been conducted in the past, highlighting the different foci of hemoglobinopathies. The North‐East of the country, essentially the border area with Tunisia, is an endemic area of sickle cell disease, posing many public health problems.Aims:The objectives of our work are:
Census of hemoglobinopathies supported at our level
Determine their epidemiological and evolutionary characteristics
Methods:This is a retrospective study, extending from January 1988 to December 2017. A regular monitoring is carried out at varying rates depending on the type of hemoglobinopathy with annual impact assessments.Results:during this period a total of 1709 cases of hemoglobinopathies, was followed and each type its epidemiological characteristics:
Major sickle cell syndromes: 1550 cases (90.7%)
Homozygous form: 960 cases (61.94%)
Double heterozygosity S / C: 99 cases (6.4%)
Double heterozygosity S / B Thalassemia: 491 cases (31.68%)
Epidemiological data: the current average age: 30.3 years [1 ‐ 69 years], the Sex ratio: 0.84, the majority of our patients come from Algerian‐Tunisian border area (79%). Inbreeding is present in 35.35% of cases, 70% of patients had at least one similar case in siblings.
Hemoglobin C: 70 cases (4.1%)
Epidemiological data: the current average age: 36 years [11 ‐ 69 years]; the Sex ratio: 0.70. Inbreeding is present in 59.69% of cases, 63% of patients had at least one similar case in siblings.
The β Thalasemia: 89 cases (5.2%)
Major form: 68 cases (76.4%)
Intermediate form: 21 cases (23.6%)
The epidemiological characteristics: the current average age: 19 years [03 ‐31 years], Sex ratio: 1.04. Inbreeding is present in 51% of cases and is 1st degree in 33.33%.Summary/Conclusion:Hemoglobin abnormalities are common in our region, mainly major sickle cell syndromes, posing a major health problem. Many efforts must be made at different levels to reduce the frequency of these abnormalities in this region and to provide adequate and above all multidisciplinary care for these patients.
PB2317 CHOICE OF VENOUS ACCESS FOR CHRONIC RED CELL EXCHANGE IN CHILDREN WITH SICKLE CELL DISEASE
Authors: Velasco P. , Guillen G. , de Heredia C. Diaz , Fernandez J. 
Published: June 2019

Background:Among the options of chronic transfusion regimen in sickle cell anemia (SCA), red cell exchange (RCE) is the most efficient method.In pediatrics, permanent venous accesses minimize venous punctions and improve the quality of life. Port‐a‐cath (PAC) are the devices with the least infectious complications.The recommended size of the PAC is related to the patient's age and weightPatients with SCA have a higher risk of thrombotic complications.Aims:Our objective is to select the most versatile and small PACs, to reduce thrombotic risk, which allow adequate flows to perform RCE.Methods:Selection of PAC marketed in Europe with one and two lumen, depending on the size of the reservoir, catheter, speed and availability in EuropeEx vivo analysis of the maximum flows tolerated by the ”Spectra Optia“ machine during the RCE procedure, using expired red blood cell concentrates and Gripper needles of 19 and 20G.Implantation of the device and analysis of the efficacy of the procedure in 2 patients with SCA in a chronic transfusion regimen for 2 yearsResults:After a first screening, the Cardiva PHS Medical 10.5fr double‐lumen PACs were analyzed; Bard 9.5 fr and Vortex Angyodinamics 11.4 fr. As a PAC of single lumen, the Smart Port CT mini Angyodinamics of 6.6 fr was analyzed, in order to use an extraction PAC and a return one for the same vessel.The catheters that showed better results were those of Angyodinamics, using Gripper of 19G and reaching flows of 25‐30 ml / min.Among these PACs, we selected the 6.6 fr of single lumen for the following reasons: smaller reservoir (more suitable for small and thin children), separate devices that allow only one of them to be replaced if a light is obstructed and because a Single‐light PAC could be sufficient if in the future Spectra Optima allows the unipuncture mode.In vivo, we successfully implanted the 2 PAC of single lumen selected in 2 patients of more than 40 kg, in which we were able to perform RCE every 6 weeks, during the last 2 years. The procedure is performed in an average of 3 hours. There have been no complications of thrombosis, obstruction or infection to date.Summary/Conclusion:The exvivo test allowed to discard devices not suitable for the procedure and to select a single lumen PAC model of 6.6 fr that allows sufficient flows to perform the chronic RCE in pediatric patients of any age and weight, minimizing the associated infectious and thrombotic risks to permanent accesses in patients with ACF.