Papers by Yvette Tanhehco
Biology of Blood and Marrow Transplantation
Journal of Clinical Apheresis, 2021
The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has led to a major pandemic. Whi... more The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) has led to a major pandemic. While vaccine development moves forward, optimal treatment continues to be explored. Efforts include an ever‐expanding number of clinical trials along with newly proposed experimental and off‐label investigational therapies; one of which is therapeutic plasma exchange (TPE). There have been a number of publications on TPE use as adjunctive therapy for coronavirus disease 2019 (COVID‐19), but no prospective randomized controlled trials (RCTs) have been completed. This article critically appraises the current available evidence on TPE as a treatment modality for SARS‐CoV‐2 infection.
Transfusion, 2020
BackgroundEntrustable professional activities (EPAs) are well‐defined, executable, observable, an... more BackgroundEntrustable professional activities (EPAs) are well‐defined, executable, observable, and measurable activities that are performed by a trainee and can be performed independently as training progresses. The purpose of this study is to develop EPAs specific for the practice of apheresis medicine (AM).MethodsMembers of the American Society for Apheresis Graduate Medical Education subcommittee developed a list of 28 apheresis medical activities linked to Accreditation Council for Graduate Medical Education milestones and competencies in five areas: (a) consultation, (b) clinical care for therapeutic apheresis, (c) clinical care for donor collections, (d) test optimization, and (e) vascular access. Ten AM experts using a validated tool to measure the quality of the EPAs (QUEPA) evaluated these activities with use of a Likert scale. Per group consensus, an activity was considered acceptable for each domain if it had received an average score greater than 3.7, and it was rated 4 ...
Transfusion and Apheresis Science, 2019
Background: In sickle cell disease (SCD), red blood cells (RBCs) containing hemoglobin S can be d... more Background: In sickle cell disease (SCD), red blood cells (RBCs) containing hemoglobin S can be denser than RBCs containing wild-type hemoglobin, especially when dehydrated. We hypothesize that targeting denser RBCs during red blood cell (RBC) exchange for SCD could result in more efficient removal of dehydrated, sickled RBCs and preservation of non-sickled RBCs. Study design and methods: Waste products from RBC exchanges for SCD were used as "simulated patients". One RBC volume was exchanged using ABO-compatible blood. The apheresis instrument was programmed to exchange the entire RBC layer by indicating the hematocrit (control), or the bottom half by indicating the hematocrit was half the hematocrit (experimental), with or without subsequent transfusion. Hemoglobin S levels, and complete blood counts were measured. Results: Hemoglobin S levels were lower after the modified versus control RBC exchange (post-RBC exchange mean 4.96% and 11.27%); total hemoglobin S amounts were also lower (mean 19.27 and 58.29 mL of RBCs). Mean RBC density decreased after the modified RBC exchange by 8.86%. Hematocrit decreased in the modified RBC exchange by 36.37%, with partial correction by direct transfusion following a truncated RBC exchange. Conclusions: Targeting denser RBCs in RBC exchange enhanced hemoglobin S removal and decreased RBC density. Further development of this ex vivo model could potentially allow for: 1) improved reduction in hemoglobin S levels (allowing for longer periods between RBC exchange or maintained lower levels), or 2) achievement of previous goal hemoglobin S levels with fewer donor units (reducing alloimmunization risk and improving blood utilization).
Biology of Blood and Marrow Transplantation, 2018
To ensure optimal clinical outcomes for patients while retaining adequate protection for donors, ... more To ensure optimal clinical outcomes for patients while retaining adequate protection for donors, the National Marrow Donor Program developed guidelines specifying that up to 20 mL/kg of bone marrow can be harvested from donors. These guidelines, originally developed for unrelated adult donors, are followed in children as well. We studied the impact of granulocyte colony-stimulating factor (G-CSF) priming on the cellular composition of harvested bone marrow, sought to develop an algorithm to optimize bone marrow harvest volume from pediatric matched sibling donors, and studied the impact of CD34 + cell dose on clinical outcomes. We analyzed data from 92 bone marrow harvests and clinical outcomes for 69 sibling recipient-donor duos, The mean age of recipients was 9.85 ± 5.90 years, and that of donors was 11.85 ± 6.36 years. G-CSF priming was not associated with higher yield of CD34 + cells/μL. The median CD34 + cell count obtained from donors was 700 cells/μL (range, 400-1700 cells/μL) in donors age <6 years, 360 cells/μL (range, 100-1100 cells/μL) in donors age 6 to 12 years, and 300 cells/μL (range, 80-800 cells/μL) in donors age >12 years (P < .001). The number of CD34 + cells infused had no impact on traditional clinical outcomes; however, it was significantly related to graft-versus-host disease/relapse/rejection-free survival. Our investigation revealed that ultimately, a CD34 + cell count of approximately 3 to 5 × 10 6 /kg was a threshold beyond which increasing CD34 + cell dose did not impact outcome. In this study, we addressed the broad question of whether harvesting up to 20 mL/kg of bone marrow from a child donor is truly necessary for optimal outcomes in every pediatric case.
Pediatric Transplantation, 2017
HPC infusions have been associated with a variety of adverse events related to either patient or ... more HPC infusions have been associated with a variety of adverse events related to either patient or HPC product‐related factors. Studies documenting infusion‐related AEs in children are limited. We reviewed HPC infusion records in 354 children. Infusion‐related adverse events were classified as follows: grade 0—absent, grade I—mild, grade II—moderate, grade III—severe, grade IV—life‐threatening, and grade V—death. The percentage of patients with grade 0, I, and II‐IV AEs was as follows: 0 = 67%, I = 23.4%, and II‐V = 9.6% (one patient had fatal anaphylactic reaction to dimethyl sulfoxide). The incidence of grade II‐IV hypertension was 7.1%. There was a higher incidence of AEs with infusion of allogeneic bone marrow versus allogeneic PBSCs (47.4% vs 25.3%, P = .001). Cryopreserved products had a lower incidence of infusion‐associated AEs compared with fresh HPC products (24% vs 39.4%, P = .003). Allogeneic HPC infusion volume (>100 mL) was a significant risk factor for infusion‐assoc...
Biology of Blood and Marrow Transplantation, 2017
Introduction: Current standard practice for bone marrow harvest (BMH) is to harvest up to 20 ml/k... more Introduction: Current standard practice for bone marrow harvest (BMH) is to harvest up to 20 ml/kg from donors. These guidelines were primarily developed for unrelated adult donors but are followed in children as well. As children generally have more robust bone marrow, CD34+ yield in pediatric donors may be adequate with a smaller BMH. Methods: We analyzed the impact of CD34 cell dose on hematopoietic recovery, infections, length of hospitalization, one year GREFS (absence of grade III-IV aGVHD, cGVHD, relapse and EFS) and calculated the CD34 cell count/ml that may potentially provide information regarding optimal BMH. Results: Data from 69 sibling recipients/donors was analyzed, 35% had malignant diseases. The median age for recipients and donors was 9.8 ± 5.9 and 11.85 ± 6.3 years, respectively. 11 donors were of equivalent weight (EW= ± 5 kg of recipient weight), 17 were underweight (UW = weight >5 kg less than recipient weight) and 41 were overweight (OW= > 5 kg of recipient weight). 50% of donors received G-CSF. The average volume of BM harvested of donor weight (ml/ kg) from EW, UW and OW donors was 16.4, 19.4 and 11.9, respectively (P < .001). The average volume of BM harvested of recipient weight (ml/kg) from EW, UW and OW donors was 17.7, 11.8, and 20.3, respectively (P < .001). The average number of CD34 cells infused in patients was 6.85 ± 3.7 × 10 6 /kg. The average CD34 cells, (10 6 /kg and 10 6 / mL) harvested from donors <6, 6-12 and >12 years of age was 11.8
American Journal of Clinical Pathology, 2012
More than 20,000 units of blood products are used each year at The Children's Hospital of Philade... more More than 20,000 units of blood products are used each year at The Children's Hospital of Philadelphia (CHOP). Of these, 25% are ordered by the anesthesiology and critical care medicine (ACCM) department. CHOP accepts 9 ACCM fellows annually.Many ACCM fellows have limited experience with pediatric transfusion medicine (TM) and blood banking in general, which results in improper utilization of blood products. At CHOP, a need was identified to educate ACCM fellows on the basic TM principles, CHOP-specific TM policies, and the general procedures of blood product testing and release. With this goal in mind, we developed a teaching curriculum in 2006 to educate the ACCM fellows. Two fellows per session were assigned a full day in the blood bank. The schedule included "hands-on" learning and lectures. Blood bank administrative and technical staff participated as instructors. Each fellow received lecture handouts and TM literature. They were also asked to submit a pretest and posttest and an evaluation form and give oral feedback. This rotation has been completed by 28 fellows. Based on the pretest and posttests, most fellows demonstrated knowledge of the definition of clinically significant antibodies and proper labeling of blood samples. Fewer fellows demonstrated knowledge of CHOPspecific policies before the rotation, but this knowledge improved after the rotation. We received 23 written evaluations with ratings of outstanding to good. As a result of the teaching curriculum, there has been an improved relationship reported between the blood bank laboratory and the anesthesiology service with less miscommunication and fewer customer complaints and occurrence reports (safety net reports) documented involving TM and ACCM departments.There has also been a steady overall improvement in client satisfaction. In the future, we plan to use this feedback to develop simulationbased learning of TM concepts for anesthesiology fellows.
Transfusion, 2015
The standard therapy for patients with chronic pancreatitis (CP) and severe abdominal pain is tot... more The standard therapy for patients with chronic pancreatitis (CP) and severe abdominal pain is total pancreatectomy (TP) followed by islet autotransplantation (IAT) to prevent the development of brittle diabetes. In adult patients, narcotic independence is achieved in up to 73% of patients 1 to 5 years after transplantation whereas insulin independence is achieved in up to 40% of patients 1 to 2 years after transplantation. Pediatric patients have shown similar outcomes for narcotic independence (up to 79%) but better outcomes for insulin independence (up to 56% 1 year after transplantation). The quality of life of both adult and pediatric patients improved significantly after TP‐IAT using the Medical Outcomes Study SF‐36 survey. IAT after pancreatectomy is also performed for patients with benign and malignant disease of the pancreas. The limited studies in this patient population suggest that IAT may be potentially beneficial for carefully selected patients when sufficient numbers o...
Journal of clinical apheresis, Jan 17, 2015
The thrombotic microangiopathy (TMA) Registry Network of North America (TRNA) is a collaborative ... more The thrombotic microangiopathy (TMA) Registry Network of North America (TRNA) is a collaborative network organized for the purpose of developing a multi-institutional registry and network to conduct clinical studies in a rare patient population. The TRNA was founded in 2013 by four academic medical centers (Columbia University Medical Center, Duke University Medical Center, University of Alabama at Birmingham, and University of Pennsylvania) to develop a national and demographically diverse dataset of patients with TMA. A clinical database was developed by network members using REDCap (Research Electronic Data Capture), a web-based database developed for clinical research. To facilitate rapid Institutional Review Board (IRB) approval at multiple sites, the TRNA utilized IRBshare, a streamlined IRB process to allow patient recruitment and enrollment into the TMA registry. This article reviews the process used to establish the TRNA network and discusses the significance of the first m...
Journal of clinical apheresis, 2014
Transfusion Medicine, 2002
Thrombosis Research, 2013
BACKGROUND-Heparin-induced thrombocytopenia (HIT) develops as a result of platelet (PLT) activati... more BACKGROUND-Heparin-induced thrombocytopenia (HIT) develops as a result of platelet (PLT) activation by anti-platelet factor 4 (PF4)/heparin complex antibodies. Despite repeated exposure to heparin, patients undergoing chronic intermittent hemodialysis (HD) rarely develop HIT. We investigated the possibility that HD decreases/removes PF4 from PLT surfaces and/or plasma, thereby disfavoring immune complex formation as a mechanism of protection against HIT. MATERIALS AND METHODS-We enrolled 20 patients undergoing chronic HD at the Penn Presbyterian Medical Center. Blood samples were drawn before, during and after treatment in the presence and absence of heparin. PF4, PF4/heparin antibody, heparin, and P-selectin levels were measured. RESULTS-No patients demonstrated clinical symptoms of HIT. PLT surface PF4 levels decreased and plasma PF4 levels increased concurrently with increase in plasma heparin concentration. In the absence of heparin, PLT surface and plasma PF4 levels were unchanged. Anti-PF4/heparin antibodies, which were non-functional by the serotonin release assay, were detectable in 8 patients. PLT surface P-selectin levels did not change during treatment.
Science Translational Medicine, 2012
Selective inhibitors of nuclear export may be a promising target for treatment of chronic lymphoc... more Selective inhibitors of nuclear export may be a promising target for treatment of chronic lymphocytic leukemia.
Science Translational Medicine, 2013
siRNAs targeting STAT3 decrease survival of tumor cells and activate the host immune system.
Science Translational Medicine, 2012
Inhibitors of Itk kinase may be useful for treating T cell malignancies.
Science Translational Medicine, 2012
iPSC-generated teratomas can be sources of hematopoietic stem cells, antibodies, and cytokines.
Science Translational Medicine, 2012
A PAR1 pepducin inhibitor prevents arterial thrombosis, but not coagulation, during coronary inte... more A PAR1 pepducin inhibitor prevents arterial thrombosis, but not coagulation, during coronary interventions.
Science Translational Medicine, 2012
Overexpression of CD39 in the lungs helps clear bacteria.
Science Translational Medicine, 2012
Inhibiting the unfolded protein response helps kill multiple myeloma cells.
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Papers by Yvette Tanhehco