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Article ; Online: Maternal and child life years gained by transfusing low titer group O whole blood in trauma: A computer simulation.

Yazer, Mark H / Leeper, Christine / Spinella, Philip C / Emery, Stephen P / Horvath, Sarah / Seheult, Jansen N

2024

Abstract: Background: Using low titer group O whole blood (LTOWB) is increasingly popular for resuscitating trauma patients. LTOWB is often RhD-positive, which might cause D-alloimmunization and hemolytic disease of the fetus and newborn (HDFN) if transfused to ... ...

Abstract	Background: Using low titer group O whole blood (LTOWB) is increasingly popular for resuscitating trauma patients. LTOWB is often RhD-positive, which might cause D-alloimmunization and hemolytic disease of the fetus and newborn (HDFN) if transfused to RhD-negative females of childbearing potential (FCP). This simulation determined the number of life years gained by the FCP and her future children if she was resuscitated with LTOWB compared with conventional component therapy (CCT). Methods: The model simulated 500,000 injured FCPs of each age between 0 and 49 years with LTOWB mortality relative reductions (MRRs) compared with components between 0.1% and 25%. For each surviving FCP, number of life years gained was calculated using her age at injury and average life expectancy for American women. The number of expected future pregnancies for FCPs that did not survive was also based on her age at injury; each future child was assigned the maximum lifespan unless they suffered perinatal mortality or serious neurological events from HDFN. Results: The LTOWB group with an MRR 25% compared with CCT had the largest total life years gained. The point of equivalence for RhD-positive LTOWB compared to CCT, where life years lost due to severe HDFN was equivalent to life years gained due to FCP survival/future childbearing, occurred at an MRR of approximately 0.1%. Conclusion: In this model, RhD-positive LTOWB resulted in substantial gains in maternal and child life years compared with CCT. A >0.1% relative mortality reduction from LTOWB offset the life years lost to HDFN mortality and severe neurological events.
Language	English
Publishing date	2024-02-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.17767
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Article ; Online: Computational Flow Cytometry Accurately Identifies Sezary Cells Based on Simplified Aberrancy and Clonality Features.

Seheult, Jansen N / Weybright, Matthew J / Jevremovic, Dragan / Shi, Min / Olteanu, Horatiu / Horna, Pedro

The Journal of investigative dermatology

2024

Abstract: Flow cytometric identification of circulating neoplastic cells (Sezary cells) in patients with mycosis fungoides and Sezary syndrome is essential for diagnosis, staging, and prognosis. Although recent advances have improved the performance of this ... ...

Abstract	Flow cytometric identification of circulating neoplastic cells (Sezary cells) in patients with mycosis fungoides and Sezary syndrome is essential for diagnosis, staging, and prognosis. Although recent advances have improved the performance of this laboratory assay, the complex immunophenotype of Sezary cells and overlap with reactive T cells demand a high level of analytic expertise. We utilized machine learning to simplify this analysis using only 2 predefined Sezary cell-gating plots. We studied 114 samples from 59 patients with Sezary syndrome/mycosis fungoides and 66 samples from unique patients with inflammatory dermatoses. A single dimensionality reduction plot highlighted all TCR constant β chain-restricted (clonal) CD3
Language	English
Publishing date	2024-01-17
Publishing country	United States
Document type	Journal Article
ZDB-ID	80136-7
ISSN	1523-1747 ; 0022-202X
ISSN (online)	1523-1747
ISSN	0022-202X
DOI	10.1016/j.jid.2023.12.020
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Article ; Online: Risk of future haemolytic disease of the fetus and newborn following the transfusion of Rh(D)-positive blood products to Rh(D)-negative children.

Yazer, Mark H / Spinella, Philip C / Seheult, Jansen N

Vox sanguinis

2021 Volume 117, Issue 2, Page(s) 291–292

MeSH term(s)	Blood Transfusion ; Child ; Erythroblastosis, Fetal/therapy ; Fetus ; Humans ; Infant, Newborn ; Rh-Hr Blood-Group System
Chemical Substances	Rh-Hr Blood-Group System
Language	English
Publishing date	2021-06-23
Publishing country	England
Document type	Letter
ZDB-ID	80313-3
ISSN	1423-0410 ; 0042-9007
ISSN (online)	1423-0410
ISSN	0042-9007
DOI	10.1111/vox.13169
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Article ; Online: Fibrinolysis Shutdown and Thrombosis in Severe COVID-19.

Seheult, Jansen N / Seshadri, Anupamaa / Neal, Matthew D

Journal of the American College of Surgeons

2020 Volume 231, Issue 2, Page(s) 203–204

MeSH term(s)	Betacoronavirus ; COVID-19 ; Coronavirus Infections ; Fibrinolysis ; Humans ; Infections ; Pandemics ; Pneumonia, Viral ; SARS-CoV-2 ; Thrombosis
Keywords	covid19
Language	English
Publishing date	2020-06-12
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	1181115-8
ISSN	1879-1190 ; 1072-7515
ISSN (online)	1879-1190
ISSN	1072-7515
DOI	10.1016/j.jamcollsurg.2020.05.021
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Article ; Online: Rate of RhD-alloimmunization after the transfusion of multiple RhD-positive primary red blood cell-containing products.

Yazer, Mark H / Triulzi, Darrell J / Sperry, Jason L / Seheult, Jansen N

Transfusion

2021 Volume 61 Suppl 1, Page(s) S150–S158

Abstract: Introduction: Early transfusion reduces mortality in bleeding patients. In this setting, RhD-positive blood products might be transfused. This study determined the association between the RhD-alloimmunization rate and the number of RhD-positive products ...

Abstract	Introduction: Early transfusion reduces mortality in bleeding patients. In this setting, RhD-positive blood products might be transfused. This study determined the association between the RhD-alloimmunization rate and the number of RhD-positive products transfused. Methods: RhD-negative patients between 13 and 50 years who were transfused with ≥1 RhD-positive red blood cell (RBC) or whole blood units between January 1, 2000 and December 31, 2019 in a healthcare network were identified. Study patients had to have had at least one antibody detection test performed ≥14 days after the index RhD-positive transfusion and not receive RhIg. Patients were stratified into groups that received 1, 2, 3-5, 6-10, 11-20, and >20 RhD-positive transfusions and the RhD-alloimmunization rate was determined for each group. Results: There were 335 patients included; 52/335 (15.5%) were females. Overall, there were 117/335 (34.9%, CI: 29.8%-40.3%) recipients who became RhD-alloimmunized. There was no significant dosage effect in the RhD-alloimmunization rates as the exposure to RhD-positive units increased from one RhD-positive unit to more than 20 RhD-positive units (p = .270 for non-parametric trend test). In an exploratory analysis, patients who received 100% of their RhD-positive transfusions within 72 h of the index transfusion had a significantly higher rate of RhD-alloimmunization compared to those who were transfused over a longer period of time (42.3% vs. 21.4%, respectively; p = .001). Conclusion: These results suggest that there may not be an increased RhD-alloimmunization risk with transfusing multiple RhD-positive units after one RhD-positive unit has been transfused. These findings need confirmation in larger studies.
MeSH term(s)	Adult ; Erythrocyte Transfusion/adverse effects ; Erythrocytes/immunology ; Female ; Humans ; Isoantibodies/blood ; Isoantibodies/immunology ; Male ; Middle Aged ; Rh-Hr Blood-Group System/blood ; Rh-Hr Blood-Group System/immunology ; Young Adult
Chemical Substances	Isoantibodies ; Rh-Hr Blood-Group System
Language	English
Publishing date	2021-07-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.16495
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Zs.A 284: Show issues

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Article ; Online: Improved semiautomated detection of TRBC-restricted Sézary cells unveils a spectrum of clonal cluster immunophenotypes.

Horna, Pedro / Otteson, Gregory / Shi, Min / Seheult, Jansen N / Jevremovic, Dragan / Olteanu, Horatiu

Blood

2022 Volume 140, Issue 26, Page(s) 2852–2856

MeSH term(s)	Humans ; Lymphocytes ; Clone Cells ; Sezary Syndrome ; Skin Neoplasms/diagnosis ; Skin Neoplasms/genetics
Language	English
Publishing date	2022-08-29
Publishing country	United States
Document type	Journal Article
ZDB-ID	80069-7
ISSN	1528-0020 ; 0006-4971
ISSN (online)	1528-0020
ISSN	0006-4971
DOI	10.1182/blood.2022017548
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Article ; Online: Establishing NK-Cell Receptor Restriction by Flow Cytometry and Detecting Potential NK-Cell Clones of Uncertain Significance.

Seheult, Jansen N / Otteson, Gregory E / Jevremovic, Dragan / Horna, Pedro / Timm, Michael M / Yuan, Ji / Morice, William G / Olteanu, Horatiu / Shi, Min

Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc

2023 Volume 36, Issue 8, Page(s) 100255

Abstract: Natural killer (NK) cells develop a complex inhibitory and/or activating NK-cell receptor system, including killer cell immunoglobulin-like receptors (KIRs or CD158) and CD94/NKG2 dimers, which are variably combined to generate the individual's NK-cell ... ...

Abstract	Natural killer (NK) cells develop a complex inhibitory and/or activating NK-cell receptor system, including killer cell immunoglobulin-like receptors (KIRs or CD158) and CD94/NKG2 dimers, which are variably combined to generate the individual's NK-cell receptor repertoire. Establishing NK-cell receptor restriction by flow cytometric immunophenotyping is an important step in diagnosing NK-cell neoplasms, but reference interval (RI) data for interpreting these studies are lacking. Specimens from 145 donors and 63 patients with NK-cell neoplasms were used to identify discriminatory rules based on 95% and 99% nonparametric RIs for CD158a+, CD158b+, CD158e+, KIR-negative, and NKG2A+ NK-cell populations to establish NK-cell receptor restriction. These 99% upper RI limits (NKG2a >88% or CD158a >53% or CD158b >72% or CD158e >54% or KIR-negative >72%) provided optimal discrimination between NK-cell neoplasm cases and healthy donor controls with an accuracy of 100% compared with the clinicopathologic diagnosis. The selected rules were applied to 62 consecutive samples received in our flow cytometry laboratory that were reflexed to an NK-cell panel due to an expanded NK-cell percentage (exceeding 40% of total lymphocytes). Twenty-two (35%) of 62 samples were found to harbor a very small NK-cell population with restricted NK-cell receptor expression based on the rule combination, suggestive of NK-cell clonality. A thorough clinicopathologic evaluation for the 62 patients did not reveal diagnostic features of NK-cell neoplasms; therefore, these potential clonal populations of NK cells were designated as NK-cell clones of uncertain significance (NK-CUS). In this study, we established decision rules for NK-cell receptor restriction from the largest published cohorts of healthy donors and NK-cell neoplasms. The presence of small NK-cell populations with restricted NK-cell receptors does not appear to be an uncommon finding, and its significance requires further exploration.
MeSH term(s)	Humans ; Receptors, Natural Killer Cell/metabolism ; Flow Cytometry ; Killer Cells, Natural/metabolism ; Receptors, KIR/metabolism ; Clone Cells
Chemical Substances	Receptors, Natural Killer Cell ; Receptors, KIR
Language	English
Publishing date	2023-06-28
Publishing country	United States
Document type	Journal Article
ZDB-ID	645073-8
ISSN	1530-0285 ; 0893-3952
ISSN (online)	1530-0285
ISSN	0893-3952
DOI	10.1016/j.modpat.2023.100255
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Article ; Online: A Case of Unexplained Cerebral Sinus Thrombosis in a 22-Year-Old Obese Caucasian Woman.

Seheult, Jansen N / Chibisov, Irina

Laboratory medicine

2016 Volume 47, Issue 3, Page(s) 233–240

Abstract: Herein, we present the case of a 22-year old obese Caucasian woman female with no acquired thrombophilic risk factors who was diagnosed with extensive cerebral sinus thrombosis. A detailed thrombophilia workup demonstrated persistently elevated ... ...

Abstract	Herein, we present the case of a 22-year old obese Caucasian woman female with no acquired thrombophilic risk factors who was diagnosed with extensive cerebral sinus thrombosis. A detailed thrombophilia workup demonstrated persistently elevated plasminogen activator inhibitor 1 (PAI-1) activity levels, with an elevated PAI-1 antigen concentration and homozygosity for the PAI-1 4G allele (4G/4G genotype). The patient was treated with indefinite warfarin anticoagulation medication due to the unprovoked nature of her thrombotic event. Disturbances in the fibrinolytic system, in particular PAI-1, have been related to an increased risk of arterial and venous thrombosis. In this article, we discuss the pathophysiology of hypofibrinolysis associated with elevated PAI-1 levels and the PAI-1 4G/5G polymorphism.
Language	English
Publishing date	2016-08
Publishing country	England
Document type	Journal Article
ZDB-ID	391758-7
ISSN	1943-7730 ; 0007-5027
ISSN (online)	1943-7730
ISSN	0007-5027
DOI	10.1093/labmed/lmw023
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Article ; Online: Benchmarking the centralized urgent plasma exchange service for patients admitted with a diagnosis of suspected acquired thrombotic thrombocytopenic purpura at a large healthcare system.

Seheult, Jansen N / Stram, Michelle N / Sevcik, Joan / Kaplan, Alesia / Kiss, Joseph E

Journal of clinical apheresis

2021 Volume 36, Issue 5, Page(s) 678–686

Abstract: Background: Consensus guidelines recommend that therapeutic plasma exchange (TPE) should be started within 4 to 8 hours after the diagnosis of suspected acquired thrombotic thrombocytopenic purpura (aTTP). This study aimed to audit the steps from ... ...

Abstract	Background: Consensus guidelines recommend that therapeutic plasma exchange (TPE) should be started within 4 to 8 hours after the diagnosis of suspected acquired thrombotic thrombocytopenic purpura (aTTP). This study aimed to audit the steps from diagnosis to initiation of plasma exchange at a centralized apheresis service. Methods: A retrospective review of the electronic medical record and laboratory information systems from January 1, 2014 to August 31, 2017 was conducted to identify all patients with suspected aTTP undergoing TPE. Demographics, comorbidities, pertinent laboratory tests, and temporal TPE procedural data were collected. Results: The median (5th-95th percentile) time from request to initiation of TPE was 5.4 (3.2-10.6) hours. TPE was initiated within 8 hours in 94 of the 108 patients (87.0%). The median (5th-95th percentile) time from request to central venous access was 2.5 (0.5-6.9) hours and from request to plasma product issuance from the blood bank was 3.4 (1.6-8.1) hours. aTTP patients in whom TPE was initiated greater than 6 hours from request did not have worse outcomes compared to those with TPE initiation within 6 hours: in-hospital mortality (2/14 [14.3%] vs 2/21 [9.5%], P = 0.66), median length of stay (9.0 [4.7-44.1] vs 8.3 [3.9-27.0] days, P = 0.76), and median number of days to durable platelet count recovery (4.5 [2.0-9.0] vs 4.0 [2.0-18.0] days, P = 0.66). Conclusions: The 4 to 8-hour target window from TPE request to initiation appears feasible for a centralized apheresis program servicing a large healthcare system.
MeSH term(s)	Adult ; Aged ; Benchmarking ; Delivery of Health Care ; Female ; Humans ; Length of Stay ; Male ; Middle Aged ; Plasma Exchange/methods ; Purpura, Thrombotic Thrombocytopenic/therapy ; Retrospective Studies ; Young Adult
Language	English
Publishing date	2021-06-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	604912-6
ISSN	1098-1101 ; 0733-2459
ISSN (online)	1098-1101
ISSN	0733-2459
DOI	10.1002/jca.21916
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Article ; Online: An unusual case of anti-D detection in two consecutive D+ patient samples: Antibody carryover on an automated gel platform.

Gabert, Kimberly / Seheult, Jansen N / Meyer, Michael P / Triulzi, Darrell J / Kaplan, Alesia

Transfusion

2021 Volume 61, Issue 9, Page(s) 2545–2548

Abstract: Background: Laboratory results can be affected by sample to sample carryover. Carryover of different analytes occurring in automated clinical chemistry, immunology, hematology, and molecular laboratories is well described. However, carryover in a ... ...

Abstract	Background: Laboratory results can be affected by sample to sample carryover. Carryover of different analytes occurring in automated clinical chemistry, immunology, hematology, and molecular laboratories is well described. However, carryover in a transfusion service laboratory is not reported in medical literature. Materials and methods: Immunohematology testing results, demographic data, and clinical data were reviewed on three patients retrospectively from 2015 to 2019. Results: Type and screen samples tested on automated gel platform from two D+ patients were affected by anti-D carryover from a patient sample with a very high-titer anti-D. Additional immunohematology and molecular testing confirmed that anti-D in samples of two D+ patients was due to carryover. Conclusion: A case of anti-D carryover caused false detection of anti-D in two D+ patients. Carryover can have implications for patient management. Transfusion laboratory staff need to be aware of it and investigate any unexpected results further.
MeSH term(s)	Female ; Hematologic Tests ; Humans ; Immunologic Tests ; Laboratories ; Male ; Middle Aged ; Pregnancy ; Quality Control ; Retrospective Studies ; Rh-Hr Blood-Group System/blood ; Rho(D) Immune Globulin/blood
Chemical Substances	RHO(D) antibody ; Rh-Hr Blood-Group System ; Rho(D) Immune Globulin
Language	English
Publishing date	2021-07-06
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	208417-x
ISSN	1537-2995 ; 0041-1132
ISSN (online)	1537-2995
ISSN	0041-1132
DOI	10.1111/trf.16578
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