Evaluation of the role of the new INNOVANCE PFA P2Y test cartridge in detection of clopidogrel resistance

Argirios Tsantes, Ignatios Ikonomidis, Ioannis Papadakis, Christine Kottaridi, Aimilia Tsante, Eleni Kalamara, Aikaterini Kardoulaki, Petros Kopterides, Violetta Kapsimali, Petros Karakitsos, John Lekakis, Anthi Travlou

Light transmittance aggregometry (LTA) has been extensively used in monitoring clopidogrel therapy. However, the availability of simple and rapid point-of-care platelet function assays is of great clinical importance. Thus, the manufacturer of the Platelet Function Analyzer (PFA)-100 System has recently produced the INNOVANCE PFA P2Y test cartridge. We assessed the ability of this new test to reliably detect clopidogrel resistance. We enrolled 90 consecutive patients with coronary artery disease receiving chronic clopidogrel maintenance therapy in combination with aspirin. Twenty healthy volunteers served as controls. Clopidogrel resistance was simultaneously analysed by the INNOVANCE PFA P2Y test cartridge, ADP-induced LTA, the flow-cytometric vasodilator-stimulated phosphoprotein (VASP)-phosphorylation assay and the multiple electrode aggregometry (Multiplate). Agreement among the four platelet function methods by two was assessed using Cohen’s kappa coefficient. According to the cut-off points for clopidogrel resistance proposed by the literature, agreement was fair between INNOVANCE PFA-100 P2Y and LTA (74.4%) and Multiplate (75.6%), while poor agreement was noticed in VASP assay (63.3%). Based on cut-off points indicating a higher thrombotic risk, agreement between the PFA-100 System and the other three methods did not significantly differ compared to the previous cut-offs (72.2%, 71.1% and 55.1%, respectively). The INNOVANCE PFA-100 P2Y test seems to be comparable to other established platelet function assays in detecting clopidogrel resistance. However, the modest agreement among platelet function methods makes the performance of platelet function testing crucial with more than one technique in order to reliably identify poor responders to clopidogrel treatment.

Platelets, September 2012; 23(6): 481–489

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Thrombomodulin as a regulator of the anticoagulant pathway: implication in the development of thrombosis

Georgia Anastasiou, Argyri Gialeraki, Efrossyni Merkouri, Marianna Politou, Anthi Travlou

Thrombomodulin is a cell surface-expressed glycoprotein that serves as a cofactor for thrombin-mediated activation of protein C (PC), an event further amplified by the endothelial cell PC receptor. The PC pathway is a major anticoagulant mechanism that downregulates thrombin formation and hedges thrombus formation. The objectives of this review were to review recent findings regarding thrombomodulin structure, its involvement in the regulation of hemostasis and further discuss the implication, if any, of the genetic polymorphisms in the thrombomodulin gene in the risk of development of thrombosis. We performed a literature search by using electronic bibliographic databases. Although the direct evaluation of risk situations associated with thrombomodulin mutations/ polymorphisms could be of clinical significance, it appears that mutations that affect the function of thrombomodulin are rarely associated with venous thromboembolism. However, several polymorphisms are reported to be associated with increased risk for arterial thrombosis. Additionally studies on knock out mice as well studies on humans bearing rare mutations suggest that thrombomodulin dysfunction may be implicated in the pathogenesis of myocardial infraction.

Blood Coagul Fibrinolysis 23:1–10

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The role of prasugrel in the management of acute coronary syndromes: a systematic review

M. Spartalis, E. Tzatzaki, E. Spartalis, C. Damaskos, A. Athanasiou, D. Moris, M. Politou

OBJECTIVE: Dual antiplatelet therapy DAPT) is the treatment of choice in the medical management of patients with acute coronary syndrome (ACS). The combination of aspirin and a P2Y12 inhibitor in patients who receive a coronary stent reduces the rate of stent thrombosis and the rates of major adverse cardiovascular events. However, patients with acute coronary syndrome remain at risk of recurrent cardiovascular events despite the advance of medical therapy. The limitations of clopidogrel with variable antiplatelet effects and delayed onset of action are well established and lead to the development of newer P2Y12 inhibitors. Prasugrel is a selective adenosine diphosphate (ADP) receptor antagonist indicated for use in patients with ACS. Prasugrel provides greater inhibition of platelet aggregation than clopidogrel and has a rapid onset of action. We have conducted a systematic review to retrieve current evidence regarding the role of prasugrel in the management of ACS. Evidence comparing prasugrel, clopidogrel, and ticagrelor remain scant.
MATERIALS AND METHODS: A complete literature survey was performed using PubMed database search to gather available information regarding management of acute coronary syndromes and prasugrel. An explorative comparison of the safety and efficacy of prasugrel, clopidogrel, and ticagrelor was also conducted.
RESULTS: Prasugrel and ticagrelor are more efficacious than clopidogrel in reducing the occurrence of non-fatal myocardial infarction, stroke, or cardiovascular (CV) death but they have also an increased risk of major bleeding in comparison to clopidogrel.
CONCLUSIONS: Prasugrel and ticagrelor are today the recommended first-line agents in patients with ACS. The estimation of which drug is superior over the other cannot be reliably established from the current trials.

Eur Rev Med Pharmacol Sci 2017; 21: 4733-4743

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Enhancing the Accuracy of Platelet to Lymphocyte Ratio after Adjustment for Large Platelet Count: A Pilot Study in Breast Cancer Patients

Charalampos Seretis, Fotios Seretis, Emmanuel Lagoudianakis, Marianna Politou, George Gemenetzis, Nikolaos S. Salemis

Background. The objective of our study is to investigate the potential effect of adjusting preoperative platelet to lymphocyte ratio, an emerging biomarker of survival in cancer patients, for the fraction of large platelets. Methods. A total of 79 patients with breast neoplasias, 44 with fibroadenomas, and 35 with invasive ductal carcinoma were included in the study. Both conventional platelet to lymphocyte ratio (PLR) and the adjusted marker, large platelet to lymphocyte ratio (LPLR), were correlated with laboratory and histopathological parameters of the study sample. Results. LPLR elevation was significantly correlated with the presence of malignancy, advanced tumor stage, metastatic spread in the axillary nodes and HER2/neu overexpression, while PLR was only correlated with the number of infiltrated lymph nodes. Conclusions. This is the first study evaluating the effect of adjustment for large platelet count on improving PLR accuracy, when correlated with the basic independent markers of survival in a sample of breast cancer patients. Further studies are needed in order to assess the possibility of applying our adjustment as standard in terms of predicting survival rates in cancer.

International Journal of Surgical Oncology, Volume 2012, Article ID 653608

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Current Practice in FFP Preparation and Use in Greece: A National Survey

Aspasia Argyrou, Serena Valsami, Abraham Pouliakis, Maria Gavalaki, Antonis Aggelidis, Vasiliki Voulgaridou, Vasiliki Pliatsika, Theofanis Adraktas, Andreas Papachronis, Chrysoula Alepi, Vasiliki Giannopoulou, Panagiotis Siourounis, Sofia Tsagia, Georges Martinis, Eftihia Kontekaki, Eleftheria Zervou, Spiridon Koliofotis, Elias Kyriakou, Athina Mougiou, Lempousi Dimitra, Afrodite Chairopoulou, Aggeliki Tsakania, Maria Baka, Ioanna Apostolidou, Dimitra Moschandreou, Anastasia Livada, Marianna Politou, Fragoula Roussinou, Christina Pappa, Vasiliki Koika, Niki Vgontza, Anthippi Gafou, Ioanna Dendrinou, Fotini Sakellaridi, Lampothea Labrianou, Zafeiria Alexandropoulou, Vasiliki Sochali, Kostas Malekas, Areti Skordilaki, Georgia Kakava, Konstantinos Lebesopoulos, Konstantinos Stamoulis, Elisavet Grouzi

Objective: Fresh frozen plasma (FFP) transfusion is widely used in modern clinical settings. Practices regarding its use vary due to lack of guidelines from randomized trials. The aim of this study was to assess both the current practices regarding FFP production, use, and wastage and the implementation of quality control (QC), female donor plasma production policies, and use of pharmaceutical hemostatic agents in Greece.
Materials and Methods: The study was conducted during February-April 2018. For the first part of the study, data including FFP transfusion indication, hospital department, diagnosis, FFP units/transfusion episode, ABO compatibility, blood donor’s sex, and reasons for discarding were collected. For the second part, questionnaire data were analyzed.
Results: According to data from 20 Greek hospitals, 12655 FFP units were transfused to 2700 patients during 5069 transfusion episodes in the studied period of time. Most patients were hospitalized in internal medicine, general surgery, and intensive care unit departments. Each patient received on average 4.69 units (2.5 units/episode). Transfusion requests were in accordance with international guidelines in 63.44% of cases and 99.04% of the units were given to ABO-identical patients. Main reasons for discarding included failure to meet quality requirements (30.06%), female donors (22.17%), and other causes (27.26%). Among 96.9% of all transfusion services across the country, 28.26% perform QC according to the directions of the European Directorate for the Quality of Medicines & Health Care and 68.83% discard plasma from female donors. Pharmaceutic hemostatic agents are used in 37.23% of the hospitals.
Conclusion: This is the first national survey regarding FFP production and transfusion in Greece. Staff of internal medicine, general surgery, and ICU departments, where most FFP-transfused patients are hospitalized, should be regularly involved in training on contemporary transfusion guidelines. Upcoming centralization of FFP production and inventory management could help in homogenizing practices regarding FFP use and improve product quality. Strengthening the use of pharmaceutic hemostatic agents could improve patients’ management.

Turk J Hematol 2021;38:22-32

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Effect of mirasol pathogen reduction technology system on immunomodulatory molecules of apheresis platelets

S. Valsami, E. Grouzi, D. Mochandreou, A. Pouliakis, M. Piroula-Godoy, S. Kokori, T. Pittaras, A. Raikou, M. Politou

Pathogen inactivation for platelets by riboflavin system (MIRASOL) efficiently reduces transfusion related pathogen transmission. However little is known about its impact on platelets’ immunomodulatory biochemical profile. We aimed was to assess the effects of MIRASOL treatment on platelet quality parameters and immunomodulatory molecules CD62P, RANTES, and CD40L in Single Donor Platelets (SDPs) resuspended in plasma (SDP-P) or T-PAS and additive solution (SDP-A). Twenty nine SDPs (15 SDP-P and 14 SDP-A) were included in the study. Samples were collected before, after MIRASOL treatment and just before transfusion. P-selectin (CD62P), RANTES, and CD40L were tested by ELISA. Platelet products quality assays were also performed. Platelet count/unit decreased after Mirasol treatment by 13 %. The pH of all units decreased over the 5-day storage period but remained above expected limits and the swirling test was positive throughout storage. Pselectin levels were not different between the three different time points in both SDPs-P and SDPs-A while RANTES levels were found to differ statistically significantly at the three different time points in all units and in the SPD-A subgroup. CD40L levels in all SDP products increased slightly during storage but this was not statistically significant. CD62P, RANTES, and CD40L in all time points were elevated in SDPs-A compared to SDPs-P but not at a statistically significant level. In conclusion MIRASOL treatment apart from RANTES increase does not seem to substantially affect platelets associated other cytokines and immunomodulatory molecules namely Pselectin and sCD40L which are implicated in immune transfusion reactions.

Transfusion and Apheresis Science 62 (2023) 103523

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Evaluation of PFA-100 closure times in cord blood samples of healthy term and preterm neonates

Serena Valsami, Maria Kollia, Vasiliki Mougiou, Rozeta Sokou, Elina Isaakidou, Maria Boutsikou, Abraham Pouliakis, Zoe Iliodromiti, Robert Carr, Theodora Boutsikou, Nicoletta Iacovidou, Marianna Politou

The investigation of neonatal platelet function remains an issue of ongoing research with conflicting results so far. The in vitro hyporesponsiveness of neonatal platelets, especially those of preterms, assessed using aggregometry and flow cytometry, is well established in both cord blood and peripheral neonatal blood [1]. However, the in vitro assessment of primary hemostasis via a platelet function analyzer (PFA) demonstrated enhanced primary hemostasis in healthy neonates compared to adults …

Clin Chem Lab Med 2020; 58(4): e113–e116

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Integration in groups of donors may modify attitudes towards blood donation

Marianna Politou, Argyri Gialeraki, Serena Valsami, Nikolaos Nearchakos, Argyrios Tsantes, Anthi Travlou, Alice Maniatis

The national needs for blood in Greece exceed 600,000 units annually (approximately 50 units per 1,000 inhabitants). The large number of transfusiondependent thalassaemia patients, car accident victims and poor implementation of “patient blood management” are the main reasons why Greeks exceed the European average of 40 donations/1,000 inhabitants needed to cover national needs…

Blood Transfus 2015; 13: 336-7

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Genetic prediction of ICU hospitalization and mortality in COVID-19 patients using artificial neural networks

Panagiotis G. Asteris, Eleni Gavriilaki, Tasoula Touloumenidou, Evaggelia-Evdoxia Koravou, Maria Koutra, Penelope Georgia Papayanni, Alexandros Pouleres, Vassiliki Karali, Minas E. Lemonis, Anna Mamou, Athanasia D. Skentou, Apostolia Papalexandri, Christos Varelas, Fani Chatzopoulou, Maria Chatzidimitriou, Dimitrios Chatzidimitriou, Anastasia Veleni, Evdoxia Rapti, Ioannis Kioumis, Evaggelos Kaimakamis, Milly Bitzani, Dimitrios Boumpas, Argyris Tsantes, Damianos Sotiropoulos, Anastasia Papadopoulou, Ioannis G. Kalantzis, Lydia A. Vallianatou, Danial J. Armaghani, Liborio Cavaleri, Amir H. Gandomi, Mohsen Hajihassani, Mahdi Hasanipanah, Mohammadreza Koopialipoor, Paulo B. Lourenço, Pijush Samui, Jian Zhou, Ioanna Sakellari, Serena Valsami, Marianna Politou, Styliani Kokoris, Achilles Anagnostopoulos

There is an unmet need of models for early prediction of morbidity and mortality of Coronavirus disease-19 (COVID-19). We aimed to a) identify complement-related genetic variants associated with the clinical outcomes of ICU hospitalization and death, b) develop an artificial neural network (ANN) predicting these outcomes and c) validate whether complement-related variants are associated with an impaired complement phenotype. We prospectively recruited consecutive adult patients of Caucasian origin, hospitalized due to COVID-19. Through targeted next-generation sequencing, we identified variants in complement factor H/CFH, CFB, CFH-related, CFD, CD55, C3, C5, CFI, CD46, thrombomodulin/THBD, and A Disintegrin and Metalloproteinase with Thrombospondin motifs (ADAMTS13). Among 381 variants in 133 patients, we identified 5 critical variants associated with severe COVID-19: rs2547438 (C3), rs2250656 (C3), rs1042580 (THBD), rs800292 (CFH) and rs414628 (CFHR1). Using age, gender and presence or absence of each variant, we developed an ANN predicting morbidity and mortality in 89.47% of the examined population. Furthermore, THBD and C3a levels were significantly increased in severe COVID-19 patients and those harbouring relevant variants. Thus, we reveal for the first time an ANN accurately predicting ICU hospitalization and death in COVID-19 patients, based on genetic variants in complement genes, age and gender. Importantly, we confirm that genetic dysregulation is associated with impaired complement phenotype.

J Cell Mol Med. 2022;26:1445–1455. 

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Heparin Binding Protein For The Early Diagnosis And Prognosis Of Sepsis In The Emergency Department: The Prompt Multicenter Study

Konstantinos Katsaros, Georgios Renieris, Asimina Safarika, Evangelia-Maria Adami, Theologia Gkavogianni, George Giannikopoulos, Nicky Solomonidi, Stamatios Halvatzis, Ioannis M. Koutelidakis, Nikolaos Tsokos, Maroula Tritzali, Pantelis Koutoukas, Cristina Avgoustou, Anil Vasishta, Evangelos J. Giamarellos-Bourboulis

Background: The validation of new biomarkers for the diagnosis and risk stratification of patients with sepsis at an early point is essential for successful treatment. Recent publications prompted us to investigate of heparin binding protein (HBP) for the emergency department (ED) admissions.
Materials and Methods: In this multicenter, cross-sectional study, HBP and procalcitonin (PCT) were measured within the first hour upon admission to the ED in plasma samples of 371 patients with signs of infection. Patients were classified into non-sepsis and sepsis by the Sepsis-3 definitions and were followed up for outcome.
Results: HBP was significantly higher in patients with sepsis and was positively correlated to PCT and C-reactive protein, absolute neutrophil and monocyte counts, creatinine, bilirubin and lactate. Sensitivity, specificity, positive predictive value, and negative predictive value of HBP more than 19.8 ng/mL for the diagnosis of sepsis was 66.3%, 44.9%, 49.3%, and 62.2%, respectively; and for prediction of early death was 100%, 41.0%, 4.5%, and 100%, respectively. Single HBP and PCT could not predict 28-day mortality; this was performed with sensitivity, specificity, positive predictive value, and negative predictive value 44.8%, 81.8%, 17.3%, and 94.6% when used in combination.
Conclusion: Admission HBP can be used as a tool for the early diagnosis of sepsis and for the risk of early death in the ED.

SHOCK, Vol. 57, No. 4, pp. 518–525, 2022

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Effect of prolonged storage on quality characteristics of recovered plasma: Is there an expiration date?

Marianna Politou, Ifigeneia Vasiliki Kontoteza, Abraham Pouliakis, Georgios Dryllis, Panagiota Fortsa, Serena Valsami

Background: Although there are guidelines on industrial manufacture of plasma-derived medicinal products, there are no clear recommendations about plasma intended for fractionation, as there is no expiry time and the effect of prolonged storage on the activity of coagulation factors is unknown.
Study and design methods: A total of 237 units of plasma stored at 30°C in the National Blood Transfusion Centre for 1 year (62 units), 5 years (75 units), and 10 years (100 units) were studied. The effect of storage time was investigated by determining the activity of clotting factors FII, FV, FVII, FVIII, FIX, FX, FXI, FXII, FXIII using coagulometric methods and antithrombin III and fibrinogen with chromogenic assays, using System BCSR > XP (Siemens Healthcare diagnostics Marburg, Germany). Albumin was measured by Medilyzer (BX, Medicon). ABO blood group was recorded and correlated with the levels of FVIII. Comparison of values between one and five, 1 and 10 and 5 and 10 years of storage was performed via the SAS for Windows 9.4 software platform (SAS Institute Inc., NC, U.S.A.).
Results: Albumin, AT III, fibrinogen, FIX, FXI, FXII, and FXIII remain rather stable even after 10 years of storage. Levels of FII, FV, FVII, FVIII, and FX decreased after 5 years of storage.
Discussion: Our study is in agreement with all the previous studies and concludes that there is a putative usability of recovered plasma and some of its coagulation factors after many years of storage at the recommended temperature.

Transfusion. 2022;62:2188–2193.

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Sex-related aspects of the red blood cell storage lesion

Vassilis L. Tzounakas, Alkmini T. Anastasiadi, Panagiotis V. Drossos, Dimitrios G. Karadimas, Serena Ι. Valsami, Konstantinos E. Stamoulis, Issidora S. Papassideri, Marianna Politou, Marianna H. Antonelou, Anastasios G. Kriebardis

Background – Several factors contribute to the manifestation of red blood cell (RBC)storage lesions, with one of the most interesting being the “donor variation effect”. Since many haematological characteristics of blood donors are sex-dependent, sex hormones and their age-dependent variation may affect the storage profile of RBCs.
Materials and methods – Fresh blood from 200 healthy male and female donors underwent haematological, biochemical and physiological analysis. Three selected groups of donors (men, n=8; pre-menopausal women, n=8; and post-menopausal women, n=4) exhibiting as similar as possible baseline values were recruited for blood donation in leukoreduced CPD/SAGM units. RBC indices, haemolysis and propensity for haemolysis, reactive oxygen species (ROS) and plasma antioxidant capacity were measured bi-weekly.
Results – Female blood was characterised by lower plasma antioxidant capacity and free haemoglobin (Hb) levels in vivo, in spite of the higher RBC osmotic fragility, compared to male blood. Comparatively low Hb concentration was also measured in stored RBCs from female donors, as in vivo. Mean corpuscular Hb (MCH), mean corpuscular Hb concentration (MCHC), and plasma antioxidant capacity were also lower in female donors throughout storage, even though baseline levels were equal to those of the male group. There was no difference in propensity of stored RBCs for haemolysis between male and female units but intracellular ROS levels were significantly lower in female RBCs. Increased end-of-storage extracellular potassium and recruitment of protein stress markers (clusterin, Hb) to the RBC membrane were observed in the units of post- vs pre-menopausal female donors at mid-storage onwards.
Discussion – Donor’s sex has an impact on Hb concentration and redox parameters of stored RBCs. In addition, menopause seems to promote RBC membrane remodelling, at least during prolonged storage. Our pilot study provides new insights on the different effects on RBC storage lesion according to sex.

Blood Transfus 2021; 19: 224-36

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Decreased incidence of EPCR 4678G/C SNP in multiple myeloma patients with thrombosis

Athina- Paraskevi Dri, Marianna Politou, Argyri Gialeraki, Tina Bagratuni, Nikos Kanellias, Evangelos Terpos

Patients with Multiple Myeloma (MM) have an increased risk of thrombosis [1]. The underlying pathogenetic mechanism has not been fully elucidated. Several disease-specific factors have been implicated in the pathogenesis of hypercoagulation. Apart from non specific factors (age, immobility, comorbidities), qualitative and quantitative defects in coagulation and fibrinolytic factors, acquired protein C resistance, as well as high proinflammatory cytokine levels are considered as triggering factors …

Thrombosis Research 132 (2013) 400–401

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Ex vivo generation of transfusable red blood cells from various stem cell sources: A concise revisit of where we are now

Evangelia-Eleni Christaki, Marianna Politou, Marianna Antonelou, Angelos Athanasopoulos, Emmanouil Simantirakis, Jerard Seghatchian, George Vassilopoulos

Blood transfusion is an essential and irreplaceable part of modern medicine, as a therapeutic modality or additional support to other clinical therapies. Nevertheless, the entire procedure from blood collection to administration, absorbs a significant amount of resources and has a number of problems that need to be addressed. The paucity of donors, the transmission of pathogenic microorganisms and the overall costs of the process have switched the scientific interest to the quest of alternative transfusion methods. The industrial ex vivo production of transfusable red blood cells capable of replacing a unit of packed red blood cells is a very attractive prospect, let alone the idea of a massive production of such a biological material. Various scientific groups, by exploiting erythropoiesis, the stem cells’ characteristics and the constantly renewed knowledge in the fields of collection, culture, preservation and expansion of stem cells, have made significant progress towards the realization of such an idea. All three major sources of stem cells, haematopoietic stem/progenitor cells, human embryonic stem cells and induced pluripotent stem cells are thought to be capable of generating adequate amounts of red blood cells. By further studying and refining the in vitro red cell production protocols, it is anticipated that the economic and biotechnological obstacles of the current methods will be overcome in the near future. This manuscript is a brief revisit of their current state of the art, potentials and obstacles that are associated with industrial and clinical application issues.

Transfusion and Apheresis Science 58 (2019) 108–112

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Retrospective Study on Prevalence, Specificity, Sex, and Age Distribution of Alloimmunization in Two General Hospitals in Athens

Marianna Politou, Serena Valsami, Georgios Dryllis, Maria Christodoulaki, Christina Cheropoulou, Abraham Pouliakis, Maria Baka, Konstantinos Stamoulis

Objective: Blood transfusion is a common lifesaving treatment but it is often complicated with alloimmunization. Previously studies in Greece have concentrated on alloimmunization in multiply transfused thalassemic patients or antenatal women. However, the relative frequency of red blood cell (RBC) alloantibodies in the general patient population has not been studied so far. The aim of the present retrospective study was to estimate the prevalence and specificity of RBC alloantibodies in a large cohort of patients in two general hospitals and their association with age, sex, and the patients’ clinic of hospitalization.
Materials and Methods: Data from 2012 to 2016 from the “Sismanogleio” and “Thriasio” general hospitals in Athens, Greece, were studied retrospectively. Statistical analysis was performed with SAS for Windows 9.4.
Results: Six hundred twenty-six patients (626/53800, 1.16%) were alloimmunized for one or more alloantibodies. The mean age was 67.99±17.56 years. Most antibodies were found in women [62.66% (438/699) in women vs. 37.34% (261/699) in men (p=0.0007)], while the vast majority of antibodies (66.81%) were found in patients aged 61-90. The most frequent antibody was anti-Kell (26.61%), followed by anti-E (16.02%), anti-D (15.02%), anti-Jka (5.87%), and anti-M (5.72%). Anti-C (81.48%, n=27) and anti-Cw (54.17%, n=24) tended to be found more often in patients with multiple antibodies. Most alloimmunized cases were found in general surgery (42.65%) and internal medicine departments (38.66%).
Conclusion: According to our results, the alloimmunization data in a general patient population in Greece were consistent with the majority of studies in the international literature. Whether a strategy at national level needs to be directed towards extending matching for the whole population or towards applying sensitive and compulsory indirect antiglobulin tests before any transfusions in order to efficiently prevent alloimmunization remains an issue of debate.

Turk J Hematol 2020;37:154-166

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Protein Z (PZ) and plasminogen activator inhibitor-1 (PAI-1) plasma levels in patients with previously untreated Hodgkin lymphoma (HL)

Georgios Boutsikas, Evangelos Terpos, Athanasios Markopoulos, Athanasios Papatheodorou, Angeliki Stefanou, George Georgiou, Zacharoula Galani, Veroniki Komninaka, Vasileios Telonis, Ioannis Anagnostopoulos, Lila Dimitrakopoulou, Konstantinos Anargyrou, Konstantinos Tsionos, Dimitrios Christoulas, Maria Gonianaki, Theophanis Giannikos, Styliani Kokoris, Kostas Konstantopoulos, John Meletis, Maria K. Angelopoulou, Anthi Travlou, Theodoros P. Vassilakopoulos

Purpose: The role of Protein Z (PZ) in conditions, such as thrombosis, inflammation or cancer, is under investigation. Plasminogen Activator Inhibitor-1 (PAI-1) is an acute phase reactant that promotes thrombosis and tumorigenesis. Subject of this work was to study PZ and PAI-1 in patients with Hodgkin Lymphoma (HL), a malignancy with inflammatory background and relatively low incidence of thrombosis.
Methods: Newly diagnosed patients were enrolled in the study. Healthy individuals were used as controls.
Results: PZ levels were higher in patients compared to controls (not significantly), while PAI-1 levels were significantly higher in patients. Both PZ and PAI-1 concentrations did not correlate with most of patients’ characteristics. Lower PZ levels at diagnosis were associated with presence of B symptoms and positive final positron emission tomography (PET) and higher baseline PAI-1 levels with positive final PET, too. PZ had a declining trend, but PAI-1 increased initially and decreased thereafter, during the treatment period.
Conclusions: Conclusively, PAI-1, but not PZ, seems to be an acute phase protein in HL. Lower PZ and higher PAI-1 levels at diagnosis may be indicative of aggressive disease. These results need further verification.

JBUON 2017; 22(4): 1022-1031

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