Spikes in demand for hospital transfusion services
INTRODUCTION Spikes in the demand for blood components represent a substantial challenge to transfusion services. Simple metrics for characterizing volatility in blood components within the hospital transfusion service have not been established. METHODS We measured the volatility of demand for blood services at a large academic urban general hospital over a 6-month period from July 2019 to December 2019 prior to the SARS-CoV2 pandemic. RESULTS Among 4416 consecutive hours assessed, there were 693 h (16%) with spikes in demand for blood components with a mean (sd) of 3.8 (2.7) spikes/day. Spikes in demand were frequently clustered. The median number of hours between spikes differed by shift (6 h for days; 3 h for evenings; 3 h for nights). The percentage of shift hours with demand spikes also differed (9% day; 19% evening; 18% night). During the study, 32,447 components were distributed to 19,431 patients. Of these, 11,819 components (36%) were distributed during hours of peak demand. Hours with a simultaneous spike in both component demand and patient demand occurred in 5% of hours or approximately once each day. CONCLUSION Demand for transfusion services was highly volatile in an unpredictable fashion. We provide an approach that could be used to benchmark spikes in demand for blood services at hospitals. Consideration of the frequency, unpredictability, and magnitude of spikes in demand may be relevant for hemovigilance programs and for strategies to determine the laboratory staffing needed for good patient care.
Polyclonal hyper immunoglobulin: A proven treatment and prophylaxis platform for passive immunization to address existing and emerging diseases
Human Vaccines & Immunotherapeutics. 2021;:1-20
Passive immunization with polyclonal hyper immunoglobulin (HIG) therapy represents a proven strategy by transferring immunoglobulins to patients to confer immediate protection against a range of pathogens including infectious agents and toxins. Distinct from active immunization, the protection is passive and the immunoglobulins will clear from the system; therefore, administration of an effective dose must be maintained for prophylaxis or treatment until a natural adaptive immune response is mounted or the pathogen/agent is cleared. The current review provides an overview of this technology, key considerations to address different pathogens, and suggested improvements. The review will reflect on key learnings from development of HIGs in the response to public health threats due to Zika, influenza, and severe acute respiratory syndrome coronavirus 2.
Intravenous immunoglobulin as a therapeutic option for patients with worsening COVID-19 under rituximab
BMJ case reports. 2021;14(6)
Severe cases of the new COVID-19 are being reported in immunosuppressed patients. The risk seems to depend on the type of immunosuppressive agents used and it is particularly important in patients under the long-lasting effect of rituximab. Information regarding the best therapeutic approach to these patients is scarce and further studies are needed. We present a case of a young woman with rheumatoid arthritis treated with rituximab (last administration 4 months before her admission). She presented with a deteriorating and prolonged SARS-CoV-2 infection, with persistent fever, significant elevation of inflammatory markers and radiological progression. Glucocorticoids and antibiotic therapy were initiated, with no response. Intravenous immunoglobulin was then used with a rapid and exuberant response, anticipating a promising role of this therapy in immunosuppressed patients with COVID-19 under the effect of rituximab.
Systemic and Oral Immunogenicity of Porcine Epidemic Diarrhea Virus Antigen Fused to Poly-Fc of Immunoglobulin G and Expressed in ΔXT/FT Nicotiana benthamiana Plants
Frontiers in Pharmacology. 2021;12
Porcine epidemic diarrhea virus (PEDV), a member of the Coronaviridae family has become increasingly probelmatic in the pig farming industry Currently, there are no effective, globally applicable vaccines against PEDV Here, we tested a recombinant PEDV vaccine candidate based on the expression of the core neutralising epitope (COE) of PEDV conjugated to polymeric immunoglobulin G scaffold (PIGS) in glycoengineered Nicotiana benthamiana plants The biological activity of COE-PIGS was demonstrated by binding to C1q component of the complement system, as well as the surface of antigen-presenting cells (APCs) in vitro The recombinant COE-PIGS induced humoral and cellular immune responses specific for PEDV after both systemic and mucosal vaccination Altogether, the data indicated that PEDV antigen fusion to poly-Fc could be a promising vaccine platform against respiratory PEDV infection © Copyright © 2021 Tien, Yang, Jang, Kwon, Reljic and Kim
How IVIG Can Mitigate Covid-19 Disease: A Symmetrical Immune Network Model
Monoclonal Antibodies in Immunodiagnosis and Immunotherapy. 2021
In this report we provide a hypothesis of how intravenous immunoglobulin (IvIg) (pooled therapeutic normal IgG) mitigates the severe disease after infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. The disease is caused by an overreaction of the innate immune system producing a cytokine storm and inflicting multiple organ damage. Our interpretation of IvIg therapy hinges on a recent analysis of the immune dysregulation in Covid-19 infection.((1)) Previous infections with common cold coronavirus induce suppressor memory B cells that inhibit an immune response to Covid-19. The repertoire of natural antibodies (IvIg) contains suppressing antibodies in a symmetrically balanced network structure. When this repertoire interacts with the imbalanced network in the infected patient, it can neutralize the suppression of an antibody response against Covid-19. The described scenario for IvIg in Covid-19 infection may also apply in the therapy of autoimmune diseases.((2)).