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Haematological Disease
Published in John S. Axford, Chris A. O'Callaghan, Medicine for Finals and Beyond, 2023
However, because the bone marrow is the source of immune effector cells, there is a risk that the transplanted immune system will attack its new host causing graft-versus-host disease (GVHD), which may cause severe morbidity or mortality. Also, as the transferred stem cells are non-self, if the recipient is not sufficiently immunosuppressed, graft rejection may occur resulting in failure of blood counts to recover after the transplant. In order to minimize the risk of these severe complications, the donor and recipient must be closely matched at the molecular level for their human leucocyte antigen (HLA) molecules (also referred to as tissue typing). In addition, the pre-existing stem cells must be eliminated by an appropriate conditioning regimen, which typically contains a combination of chemotherapy and radiotherapy. Finally, immunosuppression with ciclosporin A (or other immunosuppressive agents) must be given to prevent GVHD in the first few weeks and months after the transplant. Allogeneic HSC transplantation treats aggressive malignancies through the GVL effect. In bone marrow failure syndromes or immunodeficiencies, donor HSCs replace the patient's defective HSCs and give rise to healthy immune and blood cells.
Developments of Health Care: A Brief History of Medicine
Published in P. Mereena Luke, K. R. Dhanya, Didier Rouxel, Nandakumar Kalarikkal, Sabu Thomas, Advanced Studies in Experimental and Clinical Medicine, 2021
P. Mereena Luke, K. R. Dhanya, Tomy Muringayil Joseph, Józef T. Haponiuk, Didier Rouxel, S. Thomas
A South African surgeon, Dr. Christian Barnard (1922–2001) transplanted a human heart from one person into another’s body in 1967 at Cape Town. This first experience of clinical heart transplantation stimulated worldwide publicity and the procedure was rapidly co-opted by many surgeons. However, many patients died soon after the surgery, the number of cardiac transplants fell from 100 in 1968 to 18 in 1970 [79]. The main issue in the case of transplantation surgery was the normal tendency of the body to reject the new tissues. Significant developments in tissue typing and immunosuppressive drugs over the next 20 years have enabled more transplant procedures and enhanced recipient survival rates. In 1983, the Columbia University Medical Center launched clinical trials with cyclosporine-an immunosuppressive drugs originating from soil fungus (Discovered by Jean Borel in 1970) which was approved for commercial use (November 1983) and it is the most frequently prescribed immunosuppressant in organ transplantation [80]. When Cyclosporin was introduced as an immunosuppressive drug, many of the rejection problems were controlled. Advanced medical technology prevents organ rejection, has led to more efficient transplantation and increased demand.
Serological Typing of HLA-A, -B, and -C Antigens
Published in M. Kam, Jeffrey L. Bidwell, Handbook of HLA TYPING TECHNIQUES, 2020
In a serological tissue typing laboratory, typing and screening are inseparable procedures in maintaining and improving the quality of definition of HLA specificities. Serological tissue typing for HLA class I specificities is the routine clinical method used for various transplant programs. In renal transplantation, many centers match recipient and donors using these techniques because no other technique can achieve a result in the same time. In bone marrow transplantation, matching donor and recipient is more critical. Serological typing is still the "first line" technique in determining possible donors, but additional tests such as mixed lymphocyte culture (see Chapter 8) and class II oligonucleotide typing are performed to determine which is the most suitable bone marrow donor for a given recipient.
Mass Spectrometry-based Biomarkers for Knee Osteoarthritis: A Systematic Review
Published in Expert Review of Proteomics, 2021
Mirella J.J. Haartmans, Kaj S. Emanuel, Gabrielle J.M. Tuijthof, Ron M. A. Heeren, Pieter J. Emans, Berta Cillero-Pastor
Several imaging software, such as Lipostar [70] and SCILS are then able to visualize molecules and determine their distribution throughout the tissue. In addition, with these programs, tissue typing, segmentation and classification of molecules is possible. It gives detailed information on tissue types, cells and molecules within the tissue. For example, Cillero-Pastor et al. addresses the importance of the location of molecules within the tissue, as well as the importance to measure molecules in multiple polarities (negative and positive), which is not usually applied throughout the reviewed articles [35]. Considering these techniques, analytical programs and databases are less developed and used, the information gathered might be of high importance, but not given consideration due to lack of molecule identification. For example, an unknown molecule is detected, but not present in one of the databases.
Novel challenges in the management of immunoglobulin light chain amyloidosis: from the bench to the bedside
Published in Expert Review of Hematology, 2020
Marco Basset, Mario Nuvolone, Giovanni Palladini, Giampaolo Merlini
Imaging techniques are instrumental to detect cardiac involvement and to evaluate its severity. Several echocardiographic parameters, like myocardial strain imaging, midwall fractional shortening, and stroke volume index, confirm echocardiography as the cornerstone for the diagnosis of heart involvement in AL amyloidosis and they also provide useful prognostic information [57–60]. Late gadolinium enhancement at cardiac magnetic resonance is suggestive of cardiac amyloidosis. Moreover, this technique is capable to quantify the extracellular myocardial volume, that may represent an esteem of cardiac amyloid load and bears prognostic information beyond biomarkers [61]. The quantification of cardiac amyloid deposits can be achieved also by nuclear imaging techniques. Scintigraphy with 18Florbetaben and 18Florbetapir showed high sensitivity for amyloid detection in patients with cardiac AL amyloidosis [62,63]. On the other hand, scintigraphy with bone tracers, as 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid or pyrophosphate (Tc-DPD or Tc-PYP), is an irreplaceable tool for differential diagnosis between AL and ATTR cardiac amyloidosis. A strong myocardial uptake in the absence of a concomitant monoclonal component can allow diagnosis of ATTR amyloidosis without biopsy confirmation [64]. However, in the patients in whom a monoclonal component is detected tissue typing with adequate technologies in referral centers remains mandatory.
Oncology Coding Update 2018
Published in Oncology Issues, 2018
In CY 2017, CMS finalized C-APC 5244 (Level 4 Blood Product Exchange and Related Services) for allogeneic hematopoietic stem cell transplantation. As provided in the Medicare Claims Processing Manual, donor acquisition charges for allogeneic HSCT include charges for the costs of several services. These services include, but are not necessarily limited to, National Marrow Donor Program fees, tissue typing of donor and recipient, donor evaluation, physician pre-procedure donor evaluation services, costs associated with the collection procedure (for example, general routine and special care services, procedure/operating room and other ancillary services, apheresis services, among others), post-operative/ post-procedure evaluation of donor, and the preparation and processing of stem cells.