News in brief: Platelets activated in mild COVID-19; Inhibitor risk in haemophilia A: Deadly infections post-HCT

Thursday, 17 Jun 2021

Platelets sensitive to SARS-CoV-2 exposure

Platelet activation occurs in mild COVID-19 patients and in SARS-CoV-2 negative household contacts, according to Australian research.

The results suggest that SARS-CoV-2-exposed individuals may have a SARS-CoV-2 infection below the detection threshold but sufficient for a platelet response.

The small study of 67 adults and children showed few age-specific differences in platelet response to SARS-CoV-2 in mild COVID-19.

“The fact that platelet counts remained normal suggests that thrombocytopenia is a unique symptom of severe COVID-19,” the study said.

British Journal of Haematology

Inhibitors increase with intensity of factor VIII treatment

Intensive treatment with factor VIII increases the development of neutralising anti-FVIII antibodies (inhibitors) in patients with non-severe haemophilia A.

An international case-control study showed inhibitor patients were treated more often for surgery than controls (aOR 1.5).

In both early (before 50 exposure days) and late (>50 exposure days) inhibitor development, peak treatment moments were also associated with an increased risk of inhibitors (crude OR 1.8).

A high mean factor VIII dose was associated with both early and late inhibitor risk (crude OR 2.8)

“Therefore, persistent vigilance is required throughout the life-time treatment course of patients with non-severe haemophilia A, to prevent or early detect inhibitor development,” the study concluded.

Journal of Thrombosis and Haemostasis

Infections still the main risk post-HCT 

Infection related mortality (IRM) is the leading cause of early death for adults and children post-HCT, an Australian registry study has confirmed.

The study of 2705 adult and 689 paediatric patients with a first allogeneic HCT between 2013 and 2018 found IRM was the leading cause of death at day 100 in adults (6.2%) – ahead of relapse (1.3%), GCHD (1.5%), and other causes 2.1%.

Similarly IRM was the leading cause of death at day 100 in children (2.5%), compared to relapse (1.3%), GVHD (0.1%), and other causes (1.6%).

Relapse became the leading cause of death at 1-year post-HCT.

Only about half of infectious deaths had an identified infectious aetiology and less than half with a causative organism however Pseudomonas spp was the most common bacteria identified in adults and CMV the most common virus.

The study said strategies to reduce IRM such as individualised pre-transplant infection risk and prevention management strategies, rapid diagnostics and access to infection management expertise should be explored.

Transplantation and Cellular Therapy

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