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  • 1
    In: Archives of Pathology & Laboratory Medicine, Archives of Pathology and Laboratory Medicine, Vol. 146, No. 2 ( 2022-01-02), p. 145-153
    Abstract: Assessing direct oral anticoagulant (DOAC) drug levels by reliable laboratory assays is necessary in a number of clinical scenarios. Objective.— To evaluate the performance of DOAC-specific assays for various concentrations of dabigatran and rivaroxaban, assess the interlaboratory variability in measurement of these DOACs, and investigate the responsiveness of the routine clotting assays to various concentrations of these oral anticoagulants. Design.— College of American Pathologists proficiency testing survey data from 2013 to 2016 were summarized and analyzed. Results.— For dabigatran, the interlaboratory coefficient of variation (CV) of ecarin chromogenic assay was broad (ranging from 7.5% to 29.1%, 6.3% to 15.5%, and 6.8% to 9.0% for 100-ng/mL, 200-ng/mL, and 400-ng/mL targeted drug concentrations, respectively). The CV for diluted thrombin time for dabigatran was better overall (ranging from 11.6% to 17.2%, 9.3% to 12.3, and 7.1% to 11.2% for 100 ng/mL, 200 ng/mL, and 400 ng/mL, respectively). The rivaroxaban-calibrated anti-Xa assay CVs also showed variability (ranging from 11.5% to 22.2%, 7.2% to 10.9%, and 6.4% to 8.1% for 50-ng/mL, 200-ng/mL, and 400-ng/mL targeted drug concentrations, respectively). The prothrombin time (PT) and activated partial thromboplastin time (aPTT) showed variable dose- and reagent-dependent responsiveness to DOACs: PT was more responsive to rivaroxaban and aPTT to dabigatran. The undiluted thrombin time showed maximum prolongation across all 3 dabigatran concentrations, making it too sensitive for drug-level monitoring, but supporting its use as a qualitative screening assay. Conclusions.— DOAC-specific assays performed reasonably well. While PT and aPTT cannot be used safely to determine DOAC degree of anticoagulation, a normal thrombin time excludes the presence of dabigatran.
    Type of Medium: Online Resource
    ISSN: 1543-2165 , 0003-9985
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    Language: English
    Publisher: Archives of Pathology and Laboratory Medicine
    Publication Date: 2022
    detail.hit.zdb_id: 2028916-9
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  • 2
    In: Blood, American Society of Hematology, Vol. 140, No. 1 ( 2022-07-07), p. 73-77
    Abstract: Kanack and colleagues analyze anti-platelet factor 4 antibodies from 5 patients with vaccine-induced thrombotic thrombocytopenia (VITT) secondary to COVID-19 adenoviral vaccination and antibodies from patients with spontaneous heparin-induced thrombocytopenia (HIT) and classical HIT. VITT antibodies are monoclonal or oligoclonal, similar to spontaneous HIT, whereas classical HIT antibodies are polyclonal. Heparin inhibits antibody-induced platelet activation in VITT, suggesting that heparin should be considered for the treatment of VITT.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2022
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 3
    Online Resource
    Online Resource
    American Society of Hematology ; 2022
    In:  Blood Advances Vol. 6, No. 18 ( 2022-09-27), p. 5327-5329
    In: Blood Advances, American Society of Hematology, Vol. 6, No. 18 ( 2022-09-27), p. 5327-5329
    Type of Medium: Online Resource
    ISSN: 2473-9529 , 2473-9537
    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2022
    detail.hit.zdb_id: 2876449-3
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  • 4
    Online Resource
    Online Resource
    Oxford University Press (OUP) ; 2019
    In:  Clinical Chemistry Vol. 65, No. 1 ( 2019-01-01), p. 57-66
    In: Clinical Chemistry, Oxford University Press (OUP), Vol. 65, No. 1 ( 2019-01-01), p. 57-66
    Abstract: Transgender women are female individuals who were recorded men at birth based on natal sex. Supporting a person's gender identity improves their psychological health, and gender-affirming hormones reduce gender dysphoria and benefit mental health. For transgender women, estrogen administration has clinically significant benefits. Previous reviews have reported conflicting literature on the thrombotic risk of estrogen therapy in transgender women and have highlighted the need for more high-quality research. CONTENT To help address the gap in understanding thrombotic risk in transgender women receiving estrogen therapy, we performed a systematic literature review and metaanalysis. Two evaluators independently assessed quality using the Ottawa Scale for Cohort Studies. The Poisson normal model was used to estimate the study-specific incidence rates and the pooled incidence rate. Heterogeneity was measured using Higgins I2 statistic. The overall estimate of the incidence rate was 2.3 per 1000 person-years (95% CI, 0.8–6.9). The heterogeneity was significant (I2 = 74%; P = 0.0039). SUMMARY Our study estimated the incidence rate of venous thromboembolism in transgender women prescribed estrogen to be 2.3 per 1000 person-years, but because of heterogeneity this estimate cannot be reliably applied to transgender women as a group. There are insufficient data in the literature to partition by subgroup for subgroup prohibiting the analysis to control for tobacco use, age, and obesity, which is a major limitation. Additional studies of current estrogen formulations, modes of administration, and combination therapies, as well as studies in the aging transgender population, are needed to confirm thrombotic risk and clarify optimal therapy regimens.
    Type of Medium: Online Resource
    ISSN: 0009-9147 , 1530-8561
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2019
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  • 5
    In: American Journal of Medical Genetics Part A, Wiley, Vol. 158A, No. 3 ( 2012-03), p. 475-481
    Type of Medium: Online Resource
    ISSN: 1552-4825
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2012
    detail.hit.zdb_id: 1493479-6
    SSG: 12
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  • 6
    Online Resource
    Online Resource
    Wiley ; 2011
    In:  American Journal of Hematology Vol. 86, No. 12 ( 2011-12), p. 1032-1034
    In: American Journal of Hematology, Wiley, Vol. 86, No. 12 ( 2011-12), p. 1032-1034
    Type of Medium: Online Resource
    ISSN: 0361-8609
    URL: Issue
    Language: English
    Publisher: Wiley
    Publication Date: 2011
    detail.hit.zdb_id: 1492749-4
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  • 7
    In: Blood, American Society of Hematology, Vol. 128, No. 22 ( 2016-12-02), p. 5217-5217
    Abstract: Nitric oxide (NO) induces apoptosis and differentiation in acute myeloid leukemia (AML) cells. The NO prodrug O2-(2,4-dinitrophenyl) 1-[(4-ethoxycarbonyl)piperazin-1-yl]diazen-1-ium-1,2-diolate (JS-K) is a lead agent of the arylated diazeniumdiolate class. JS-K is active in vitro and in vivo against AML, multiple myeloma, and several solid tumors. JS-K is directly cytotoxic to malignant cells and inhibits angiogenesis in vitro and in vivo. We have previously shown that JS-K is not toxic towards normal murine hematopoietic cells. Aiming at its clinical application to treat AML, we have developed a nanoscale micelle formulation for JS-K (P123/JS-K) using Pluronic®P123 polymers. The formulation (P123/DMSO) consists of 2.25% P123 and 2% dimethyl sulfoxide in phosphate buffered saline. P123/JS-K is currently at an advanced stage of pre-clinical development. Here, we compared the cytotoxicity of JS-K and its formulation between normal hematopoietic and AML cells. HL-60 AML cells or normal human CD34+ cells isolated from 2 different cord blood units were treated for 24 hours with P123/DMSO or P123/JS-K before plating in semi-solid media. Colonies were scored at 10 days. P123/DMSO alone had no effect on colony formation by HL-60 or normal CD34+ cells. P123/JS-K at concentrations of 0.1, 0.25, and 0.5 μM inhibited HL-60 colony growth by 27, 74, and 100%, respectively (P 〈 0.05 for the comparison between 0.25, 0.5 μM and controls). At the same concentrations, P123/JS-K inhibited the growth of erythroid colonies from the first cord blood sample, by 26, 43, and 61%, respectively. At a concentration of 0.1 μM, P123/JS-K did not inhibit the growth of erythroid colonies from the second cord blood sample but inhibited erythroid colony growth by 18, and 27% at concentrations of 0.25 and 0.5 μM, respectively. However, the differences with untreated controls were not statistically significant for either cord blood sample. At the same concentrations P123/JS-K inhibited the growth of myeloid colonies from the first cord blood sample, by 8, 3, and 37%, respectively. At a concentration of 0.1 μM, P123/JS-K did not inhibit the growth of myeloid colonies from the second cord blood sample but inhibited myeloid colony growth by 2, and 6% at concentrations of 0.25 and 0.5 μM, respectively. However, the differences with untreated controls were not statistically significant for either cord blood sample. With clinical development in mind, we also sought to determine whether the P123/DMSO formulation affects platelet function. P123/DMSO was added to normal donor blood obtained in either EDTA or citrate anticoagulant. With either anticoagulant, P123/DMSO did not affect the measured hemoglobin, white blood cell, or platelet counts. Inspection of peripheral blood smears (Wright stain) obtained with either anticoagulant revealed no platelet clumping. We then studied the effect of P123/DMSO on platelet aggregation in vitro in response to ADP, collagen, ristocetin, or arachidonic acid. Light transmission platelet aggregometry was performed using platelet-rich plasma from a healthy volunteer with normal platelet counts and function. In order to determine whether P123/DMSO could enhance or inhibit platelet aggregation, we chose a range of agonist concentrations from sub-threshold to concentrations expected to induce complete aggregation. P123/DMSO was added at a concentration expected to be equal to peak in vivolevels based on a prior dog toxicology study. Normal aggregation responses were observed in the saline control. There were no significant differences between this control and responses observed in the presence of P123/DMSO. Specifically, significantly decreased aggregation in P123/DMSO-treated platelets was not observed in response to agonists expected to elicit complete aggregation responses. Likewise, enhanced aggregation was not observed in response to sub-threshold agonist concentrations. Our results confirm the potent anti-leukemic activity and limited toxicity against normal human hematopoietic cells of JS-K formulated in P123 micelles. Furthermore, the formulation does not affect platelet aggregation. We therefore expect that P123/JS-K will have a favorable hematologic toxicity profile and as such, will constitute an important addition to our armamentarium for the treatment of AML. Disclosures Deininger: Gilead: Research Funding; BMS: Consultancy, Research Funding; CTI BioPharma Corp.: Membership on an entity's Board of Directors or advisory committees; Novartis: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Incyte: Consultancy, Membership on an entity's Board of Directors or advisory committees; Pfizer: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Celgene: Research Funding; Bristol Myers Squibb: Consultancy, Research Funding; Ariad: Consultancy, Membership on an entity's Board of Directors or advisory committees. Shami:JSK Therapeutics: Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Research Funding.
    Type of Medium: Online Resource
    ISSN: 0006-4971 , 1528-0020
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    Language: English
    Publisher: American Society of Hematology
    Publication Date: 2016
    detail.hit.zdb_id: 1468538-3
    detail.hit.zdb_id: 80069-7
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  • 8
    Online Resource
    Online Resource
    Archives of Pathology and Laboratory Medicine ; 2020
    In:  Archives of Pathology & Laboratory Medicine Vol. 144, No. 9 ( 2020-09-01), p. 1057-1066
    In: Archives of Pathology & Laboratory Medicine, Archives of Pathology and Laboratory Medicine, Vol. 144, No. 9 ( 2020-09-01), p. 1057-1066
    Abstract: As pharmacogenetic testing is incorporated into routine care, it is essential for laboratories to provide accurate and consistent results. Certified laboratories must successfully complete proficiency testing. Objectives.— To understand and examine trends in participation and performance of laboratories participating in the College of American Pathologists pharmacogenetic proficiency testing surveys. Design.— Results from College of American Pathologists pharmacogenetic proficiency testing challenges from 2012 through 2017 were reviewed for concordance with expected genotype and phenotype for each sample (intended responses). Results.— Laboratories correctly reported results for 96.7% to 100% of samples with no variants. Excluding CYP2D6, laboratories correctly detected and reported variant alleles for each gene (93.7%–99.2% correct). CYP2D6 showed lower concordance, with 83.1% of laboratories reporting the intended genotype across all samples; however, in many cases, the laboratories that did not report a variant allele did not test for that allele. Among laboratories reporting the intended genotype, most successfully reported the intended phenotype (85.9%–99.0%). Conclusions.— Although laboratories are generally performing well, there is room for additional improvement, particularly for challenging genes, such as CYP2D6. Efforts in the field of pharmacogenomics to recommend alleles that should be included in clinical tests, identify reference materials, and standardize translation from genotype to phenotype may address some of the remaining variability in results.
    Type of Medium: Online Resource
    ISSN: 1543-2165 , 0003-9985
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    Language: English
    Publisher: Archives of Pathology and Laboratory Medicine
    Publication Date: 2020
    detail.hit.zdb_id: 2028916-9
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  • 9
    In: Annals of Internal Medicine, American College of Physicians, Vol. 166, No. 5 ( 2017-03-07), p. 361-
    Type of Medium: Online Resource
    ISSN: 0003-4819
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    Language: English
    Publisher: American College of Physicians
    Publication Date: 2017
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  • 10
    In: Archives of Pathology & Laboratory Medicine, Archives of Pathology and Laboratory Medicine, Vol. 141, No. 2 ( 2017-02-01), p. 279-287
    Abstract: Context.—Statistical literacy can be defined as understanding the statistical tests and terminology needed for the design, analysis, and conclusions of original research or laboratory testing. Little is known about the statistical literacy of clinical or anatomic pathologists. Objective.—To determine the statistical methods most commonly used in pathology studies from the literature and to assess familiarity and knowledge level of these statistical tests by pathology residents and practicing pathologists. Design.—The most frequently used statistical methods were determined by a review of 1100 research articles published in 11 pathology journals during 2015. Familiarity with statistical methods was determined by a survey of pathology trainees and practicing pathologists at 9 academic institutions in which pathologists were asked to rate their knowledge of the methods identified by the focused review of the literature. Results.—We identified 18 statistical tests that appear frequently in published pathology studies. On average, pathologists reported a knowledge level between “no knowledge” and “basic knowledge” of most statistical tests. Knowledge of tests was higher for more frequently used tests. Greater statistical knowledge was associated with a focus on clinical pathology versus anatomic pathology, having had a statistics course, having an advanced degree other than an MD degree, and publishing research. Statistical knowledge was not associated with length of pathology practice. Conclusions.—An audit of pathology literature reveals that knowledge of about 12 statistical tests would be sufficient to provide statistical literacy for pathologists. On average, most pathologists report they can interpret commonly used tests but are unable to perform them. Most pathologists indicated that they would benefit from additional statistical training.
    Type of Medium: Online Resource
    ISSN: 0003-9985 , 1543-2165
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    Language: English
    Publisher: Archives of Pathology and Laboratory Medicine
    Publication Date: 2017
    detail.hit.zdb_id: 2028916-9
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