Vasileios L. Tzounakas is a Post-doctoral researcher at the Department of Biology (Section of Cell Biology & Biophysics) of the National and Kapodistrian University of Athens (NKUA). He has obtained Ph.D. in Cell Biology. He has served as reviewer in international journals while his main research interests include blood transfusion biology (mainly, red blood cell storage lesion in blood products used for transfusion), erythrocyte biology in health and disease and the study of extracellular vesicles. In particular, he has expertise in evaluating the key parameters that affect storage lesion and posttransfusion performance of red blood cells and in the management of blood supplies in a way that will lead to the individualization of transfusion therapy. In this context, he has focused on the elucidation of storage lesion’s features that may serve as a donor’s signature, namely “the donor variation effect”.
Statement of the Problem: During their preservation at blood banks, red blood cells (RBCs) undergo several physiological alterations/deteriorations collectively known as “RBC storage lesion”. A significant part of the storage lesion is driven by oxidative stress, while some of its critical aspects are considered donor-related. Having in mind that serum uric acid (UA) represents almost 60% of the total antioxidant capacity of the donor’s plasma, the aim of this study was to provide evidence regarding the potential usefulness of UA as a donor-specific marker of storage quality. Methodology & Theoretical Orientation: For this purpose, 47 non-leukoreduced units of RBC concentrates in CPDA-1 produced from male regular blood donors were stored for 35 days. Several storage quality parameters (cell shape, redox homeostasis, extracellular vesicles/EVs etc.) were examined at the beginning (day 2), the middle (day 18) and the end (day 35) of the storage period. SPSS was used for statistical analysis. Findings: Antioxidant capacity of the blood bags’ supernatant was correlated with the UA levels i n v i v o (R=0.718, p<10-7) throughout the storage period. A posteriori splitting of the donors in high- and low-UA groups, revealed statistically lower intracellular ROS and calcium accumulation after the middle of storage (p<0.05) in the high UA group. Finally, units from high UA donors demonstrated lower levels of irreversibly modified RBCs (22.5±2.9% vs 27.1±1.6%) and different size distribution of EVs on day 35 of storage (p<0.05). Conclusion & Significance: Variability in UA levels in vivo\r\n is maintained during storage and of note, it seems to be \r\nassociated with the redox status and morphology of stored RBCs. Uric acid as a donor’s signature in blood components may be a very promising candidate biomarker of RBC storage lesion. This study was supported by “IKY FELLOWSHIPS OF EXCELLENCE FOR POSTGRADUATE STUDIES IN GREECE – SIEMENS PROGRAM” to Vasileios Tzounakas.
Mauro Laudicella is a Senior Lecturer in Health Economics in the School of Health Sciences at City University London and an Honorary Research Fellow in the Business School at Imperial College London. He is currently leading a three-year research programme investigating the costs of cancer in England sponsored by Macmillan Cancer Support. He has actively contributed to several funded research grants investigating various topics in health economics, including: value for money in health care, patient choice and competition, equity, and diffusion of new technologies for the treatment of cancer. His research has been published in the Journal of Health Economics, Social Science & Medicine, Health Services Research and Health Affairs
Background: Studies on alternative routes to diagnosis stimulated successful policy interventions reducing the number of emergency diagnoses. A dearth of evidence on costs might prevent new policies from achieving more ambitious targets. Methods: Retrospective cohort study on colorectal (88,051), breast (90,387), prostate (96,219), and lung (97,696) cancer patients diagnosed after a GP referral or an emergency presentation (EP) in the English Cancer Registry. Costs of care and survival were compared one year before and five years after diagnosis, including non-conversion costs. Basu-Manning estimator was used to calculate the effect of rerouting patients after risk-adjusting. Results: The cost per year of life saved is £6,456 in colorectal, £1,057 in breast, -£662 in prostate (savings), and £819 in lung cancer (three years only). Reducing the overall proportion of EP to those achieved by the 20% of CCGs with the lowest EP percentage would result in £11,481,948 against 1,863 years of life saved for Colorectal, £847,750 against 889 years for breast, -£943,434 (cost savings) against 1,195 years for prostate, and £609,938 against 1,011 years for lung cancer. Conclusion: Rerouting diagnoses from EP to GP/TWW referral appears an achievable target that can produce large benefits to patients against modest additional costs to the NHS.\r\n