P087 Retrospective review of blood transfusion requirements of adult patients on extracorporeal membrane oxygenation (ECMO)

Posters, ISH EAD 2007, Budapest, Hungary, 29 August Patient and Methods: This was a prospective randomized, single-center, open-label, 12-week case-control study of epoetin alfa in pediatric patients with acute lymphoblastic leukemia (ALL) in remission receiving maintenance chemotherapy. Sixty patients were randomly assigned to receive either epoetin alfa (rHuEPO group = 30 cases, 17 males & 13 female), or no epoetin alfa (control group = 30 cases, 16 males & 14 females). Both groups were matched as regard age, sex, baseline Hb concentration, remission state, chemotherapy regimen, numbers and amount of blood transfusion, and leukemia state (both were low and standard risk). The median age was 7 years (range 3 11 y). Epoetin alfa was administered at a dose of 450 IU/kg, once weekly, subcutaneously (sc) for 12 consecutive weeks. Endpoints were changes in hematologic and quality of life (QOL) parameters. Results: Among the 30 patients evaluable for hematologic response, the mean increase in Hb from baseline to time of final evaluation was 2.0±1.2 g/dl (p < 0.05). An increase in Hb of
2 g/dl, in the absence of blood transfusion, occurred in 70% of patients (21 of 30 patients) who were on the study for
30 days. The overall response rate (Hb increase
2 g/dl or Hb
12 g/dl in the absence of blood transfusion) was 80% (24 of 30 patients). In 30 patients who were evaluable for QOL assessment, epoetin-a therapy was found to significantly (p < 0.05) improve mean Cancer Linear Analog Scale (CLAS) scores for energy level, ability to perform daily activity, and overall QOL from baseline to the time of final evaluation. QW epoetin-a was found to be well tolerated. Conclusion: Treatment with QW epoetin-a was found to increase Hb levels, decrease transfusion requirement, and improve functional status and QOL in anemic patients with ALL in maintenance receiving chemotherapy. The once-weekly schedule is convenient, safe, and may reduce the burden on patients, parents, and their caregivers by reducing the number of visits to the clinic. Corresponding Author: Dr. Nabil Abdelrazik, M.D Associate professor of pediatrics, Mansoura University Children’s Hospital, Mansoura Faculty of Medicine, Mansoura, Egypt Keywords: childhood ALL, cancer-induced anemia, epoetin-a, hemoglobin (Hb), quality of life (QOL), P087 Retrospective review of blood transfusion requirements of adult patients on extracorporeal membrane oxygenation (ECMO) A.L. Ang1 *, S.L. Tien1 , C.H. Lim2 , M. Koh1,3 . 1 Singapore General Hospital, Haematology, Singapore, 2 National Heart Centre, Cardiothoracic Surgery, Singapore, 3 Centre for Transfusion Medicine, Singapore Introduction: ECMO is increasingly being used in adults with cardiac and/or respiratory failure. These patients have high transfusion requirements and have bleeding tendencies due to associated thrombocytopenia and systemic heparinistion required to prevent clotting within the ECMO. This study described blood and platelet requirements of adult patients on ECMO in our institute, and determined factors associated with high transfusion requirements. Methodology: A retrospective analysis was done on the amount of packed red cells or whole blood (rbc), and random platelets (plt) received by 41 adult patients while on ECMO, from June 2003 to September 2006. One apheresis platelet unit was counted as six plt. Various patient and ECMO characteristics were also analysed to determine factors associated with increased blood or platelet transfusion. Results: 31 males and 10 females (median age 50 years) underwent 42 ECMO sessions (88% venoarterial, 12% venovenous) for respiratory failure (9%), cardiac failure (74%) or both (17%). They received a total of 569 rbc and 852 plt during a median ECMO duration of 5 (1 15) days. Median of the total rbc, maximum daily rbc and average daily rbc are 10.5 (0 42),

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4 (0 14) and 2.2 (0 7.4) units respectively; the same parameters for plt are 14.5 (0 74), 6 (0 18) and 3.1 (0 11.3) units respectively. Multivariate analysis showed that total rbc was increased with increased ECMO duration (P = 0.000), decreased haemoglobin(Hb) nadir during ECMO (HbECMO) (P = 0.001) and presence of major bleeding requiring intervention (bleedmajor ) (P = 0.026). It also showed that average daily rbc increased with decreased HbECMO (P = 0.000) and bleedmajor (P = 0.045); total plt was increased with increased ECMO duration (P = 0.000); average daily plt was increased with the use of antiplatelets within seven days (P = 0.011) and decreased if death occurred during ECMO (P = 0.016); and average daily rbc of >2 (P = 0.001) was significantly associated with Hb < 8 g/dL. Conclusion: Above data suggested that average daily rbc was increased in adult ECMO patients with significant bleeding and HbECMO(especially <8 g/dL) while recent antiplatelets increased average daily plt requirement. Longer ECMO duration also increased total transfusion requirements. Patients with these risk factors may be identified early to allow the blood bank to optimize its blood products support. P088 Study of EC cells in patients with pernicious anemia L. Macukanovic-Golubovic *, M. Milenovic, G. Marjanovic, M. Vucic, E. Simonovic, M. Mladenovic, G. Rancic. Clinic of Haematology, Clinic of Pathology, Institute of Histology and Embriology, School of Medicine Nis, Nis, Serbia Enterochromathophine (EC) cells are the members of diffuse neuroendocrine system and are classified according to ultrastructure characteristics as EC1-intestinal type; EC2duodenal type and ECn-gastric type. Gastric type EC cells are argirophylic and argentaphylic in 10 20%. They are localized in antral and corporal gastric mucosa. In pathologic conditions EC cells can change their number, morphology and cytochemical characteristics, so as their functions. The aim of this study is to investigate presence, type and granularity EC cells in patient with pernicious anemia (PA). During the period from 1997 to 2006 (Clinic of Haematology-Nis), 96 patients with PA were examined as well as 30 patients with dyspeptic syndrome (control group). Classical (HE) histological method was used for pathological evaluation of gastric mucosa. Grimelius (argyrophilic) and Massons (argentaphilic) methods were used for the identification of EC cells. Hyperplasia, metaplasia and hypergranularity of EC cells were found in corporal mucosa of PA patients. The number of EC cells was increased proportionally to the changing of gastric mucosa and the grade of intestinal metaplasia (22 to 43 cells/per field). Sometimes, EC cells hyperplasia is of so high grade that resemble intramucous carcinoidosis. EC cells were transformed from close type to the open type: they become a triangle shape with a high amount of serotonin in them. These results can confirm that newly formed, intestinal type of EC cells secrete high quantity of serotonin increasing permeability and inducing the retrograde diffusion of H ions in gastric mucosa. Meanwhile, H ions induce acidosis and inhibit cellular metabolism, leading to citolysis of all attached cells. Serotonin stimulates synthesis of acid mucins and has an inhibition effect on HCL secretion. Hyperplasia and metaplasia of EC cells could be important for the cancer genesis through serotonine effects. P089 Ferritine, transferrine and IST as a bone marrow iron depot predictor M. Barb´ on, E. de Cabo *, R. Carre˜ no, A.M. Ojea, M.J. Moro. Hospital de Le´ on, Hematology Service, Spain Introduction: Straight evidence for iron depot detection in human organism (macrophagical iron, flebotomy test, . . . ) are the most specific and sensitive as they allow us to value the iron content reserves in a direct way. Indirect tests are much more accesible to the clinic method than the others but less