Venous thrombosis occurred more than twice as often after placement of a PICC catheter than when conventional catheters were used. One study looked more closely at influencing factors in patients after hematopoietic stem cell transplantation. Thalassemia is a genetic disorder of hemoglobin formation. In severely affected individuals, chelation therapy may be necessary to remove the excess iron from the blood. Early detection of graft-versus-host disease was the goal of another study.
In patients undergoing hematopoietic stem cell transplantation, a central static catheter is often used because the tip of the catheter reaches the superior vena cava, which facilitates rapid distribution and dilution of stimulatory chemotherapy drugs after they enter the circulation, thereby reducing stimulation of chemotherapy drugs at the vascular intima. The PICC is often considered in the clinic as a safe, effective, and painless intravenous conduit for sufferers receiving large amounts of chemotherapy drugs, blood products, and nutritional supplements. However, as a kind of foreign body, the PICC catheter is inserted into the patient’s blood vessel, which can lead to blockage of blood flow in the vessel and blood stasis. Catheter-related thrombosis is one of the most common and serious complications of clinical use of PICC technology, which can lead to prolonged hospitalization and increased hospital costs in patients with hematologic tumors and, in severe cases, can be life-threatening. A study was conducted to compare the clinical features of upper limb venous thrombosis at different stages after peripheral venipuncture with central venous catheter (PICC) in hematopoietic stem cell transplant patients and to explore factors influencing thrombosis [1].
This retrospective study was performed in 120 patients with hematopoietic stem cell transplantation after PICC catheterization. Patients with PICC-associated upper extremity venous thrombosis (PICC-CRT) 1 to 30 days after catheterization were in the recent thrombus group, and patients with PICC-CRT 31 to 210 days after catheterization were in the late thrombus group. A total of six cases of PICC-CRT occurred. The incidence was 5%. The incidence of asymptomatic thrombosis was higher in the recent thrombus group, and the incidence of symptomatic thrombosis was higher in the long-term thrombus group. There were statistically significant differences in the number of catheter lumens and complications between the two groups. After anticoagulation and thrombolytic therapy, the grading of venous thrombosis was better in the group with short-term thrombus than in the group with long-term thrombus.
Iron overload in the kidney
Iron overload is a common complication of thalassemia major (TM) that can lead to organ damage and increased morbidity. Multiecho T2* magnetic resonance imaging (MRI) is a well-established technique for assessing iron overload in the heart and liver, but there are few reports in the kidneys. Therefore, the aim of a multicenter study was to investigate the frequency, pattern, and correlates of renal iron accumulation in TM [2]. Iron overload of the liver, heart, pancreas, and kidneys of 73 patients was quantified using the gradient echo T2* technique. In each kidney, T2* was measured in the anterior, posterolateral, and posteromedial parenchymal regions, and the global T2* value was calculated as the average of the T2* values of the two kidneys.
Systemic T2* differences were observed between the left and right kidneys, with significantly lower values in the right kidney. Iron deposition in the kidney was not very common in TM, but it correlated with hemolysis and iron deposition in the liver and pancreas.
Prediction of graft-versus-host disease.
Severe acute graft-versus-host disease (aGVHD) is an important cause of death in the early posttransplant period. To improve the prognosis of allo-HSCT recipients, it is particularly important to predict the occurrence of GVHD early, before clinical symptoms appear. One study investigated the dynamic changes of leukocytes and neutrophils in patients with hematologic diseases after transplantation [3]. The aim was to develop a clue for the early diagnosis and treatment of aGVHD.
Seventy-nine hospitalized patients with hematologic diseases were selected as study participants, and their clinical data were retrospectively analyzed to investigate the correlation between aGVHD and blood routine changes and to provide a diagnostic basis for further clinical management and prevention. This showed that the neutrophil recovery rate after allo-HSCT may be one of the assessment indicators for the occurrence of aGVHD after transplantation. This clinical value now remains to be verified with a large sample.
Congress: 28th Annual Congress of the European Hematology Association (EHA) 2023
Literature:
- Tang J, Sun A, Wen J, et al: Upper limb venous thrombosis associated with picc and is influencing factors in patients with hematopoietic stem cell transplantation. HemaSphere 2023; 7(S3): 5031-5032.
- Meloni A, Barbuto L, Pistoia L, et al: Frequency, pattern and clinical correlates of renal iron accumulation in thalassemia major. HemaSphere 2023; 7(S3): 4808-4809.
- Lai S, Li X, Zhang S, et al: The rate of neutrophil recovery is helpful in predicting acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation: an obervational cohort study. HemaSphere 2023; 7(S3): 4676-4677.
InFo ONCOLOGY & HEMATOLOGY 2023, 11(4): 41.
