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Klim Gerasimov
Klim Gerasimov

The Bloody Crisis ~REPACK~



All types are needed now, especially types O positive and O negative, as well as platelet donations, to help reverse this national blood crisis. If there is not an immediate opportunity available to donate, donors are asked to make an appointment in the days and weeks ahead to ensure the Red Cross can replenish and maintain a sufficient blood supply.




The Bloody Crisis


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In January 2022, the American Red Cross declared its first-ever national blood crisis due to a severe blood shortage resulting from complications of the COVID-19 pandemic. During that time, hospitals and physicians were forced to make difficult decisions about how to best use the limited available supply of donated blood.


BLOOD DONORS HELP OVERCOME CRISIS After the Red Cross issued the national blood crisis alert, there was a strong response from the public with many generous individuals rolling up a sleeve to donate to help those in need, like Kristen. Thanks to the support of countless blood donors, the blood supply slowly recovered to sufficient levels by spring 2022, ensuring patients could receive the medical care they needed.


The organization said on Tuesday that the "national blood crisis" is threatening patient care and forcing doctors to make tough choices about who is able to receive blood transfusions, and it's urging people to donate.


Since the beginning of the pandemic, fewer people have donated blood. That's led to a shortage that the American Red Cross is now calling a blood crisis. It's especially a problem in rural parts of the country. Montana Public Radio's Aaron Bolton has more.


BOLTON: That's why, for the first time, the Red Cross has declared a blood crisis. The Blood Centers of America and others also say they are grappling with a major supply shortage. Claudia Cohn is the chief medical officer for the Association for the Advancement of Blood and Biotherapies. Cohn says the supply issue is really bad nationwide.


Pain is the most common complication of SCD, and the top reason that people with SCD go to the emergency department or hospital. Sickled cells traveling through small blood vessels can get stuck and block blood flow throughout the body, causing pain. A pain crisis (vaso-occlusive episode or VOE) can start suddenly, be mild to severe, and can last for any length of time. Pain can occur in any part of the body, but commonly occurs in the hands, feet, chest, and back.


Blast crisis (BC) remains the major challenge in the management of chronic myeloid leukemia (CML). It is now generally accepted that BC is the consequence of continued BCR-ABL activity leading to genetic instability, DNA damage, and impaired DNA repair. Most patients with BC carry multiple mutations, and up to 80% show additional chromosomal aberrations in a nonrandom pattern. Treatment with tyrosine kinase inhibitors has improved survival in BC modestly, but most long-term survivors are those who have been transplanted. Patients in BC should be treated with a tyrosine kinase inhibitor according to mutation profile, with or without chemotherapy, with the goal of achieving a second chronic phase and proceeding to allogeneic stem cell transplantation as quickly as possible. Although long-term remissions are rare, allogeneic stem cell transplantation provides the best chance of a cure in BC. Investigational agents are not likely to provide an alternative in the near future. In view of these limited options, prevention of BC by a rigorous and early elimination of BCR-ABL is recommended. Early response indicators should be used to select patients for alternative therapies and early transplantation. Every attempt should be made to reduce or eliminate BCR-ABL consistent with good patient care as far as possible.


Blast crisis (BC) is the major remaining challenge in the management of chronic myeloid leukemia (CML). The introduction of an inhibitor targeted at the BCR-ABL tyrosine kinase (imatinib) has fundamentally changed treatment of CML.1 BCR-ABL expression can be reduced by imatinib to very low or nondetectable levels in the majority of patients.2 Median survival in chronic phase (CP) is estimated at a median of 25 to 30 years. Progress to advanced phase CML or BC has been reduced to 1% to 1.5% per year1 compared with more than 20% per year in the pre-imatinib era.3 Prevalence of CML is estimated to increase by a factor of approximately 10 within the next 40 years.4 Once BC has appeared, however, the prognosis of imatinib-treated patients is not much better than that after conventional therapy.5 Median survival after diagnosis of BC currently ranges between 7 and 11 months compared with 3 to 4 months in the pre-imatinib era. Very few long-term survivors after diagnosis of BC have been reported. Most of these represent recipients of transplants during a second CP. The therapeutic dilemma of BC has recently been well summarized.6 More research is needed to fully understand the mechanisms underlying progression to BC. It is distressing that in CML BC a true malignancy evolves under our eyes. The 2 current burning questions in CML are: How can we best manage patients who progress to BC despite appropriate treatment? How can we best prevent BC?


Mechanisms of BCR-ABL activity in CML and blast crisis, leading to stimulation of proliferation and to induction of genetic instability, DNA damage, and impaired DNA repair. Reactive oxygen species induced by BCR-ABL are thought to mediate DNA damage and genetic instability. Data are from Skorski,34 Melo and Barnes,31 Radich,32 and Perrotti et al.33


Prevention of BC by more effective treatment in early CP as shown by the cumulative incidence of blast crisis (German CML Study Group experience 1983-2011). CML study I compared busulfan versus hydroxyurea (HU) versus interferon-α (IFN) monotherapy, CML study II IFN in combination with HU versus HU alone, CML study III and IIIA IFN in combination with intensive chemotherapy versus allo-SCT and CML study IV imatinib 400 mg versus imatinib in combination with low-dose cytosine arabinoside versus imatinib in combination with IFN versus imatinib after IFN failure versus imatinib at 800 mg.42


CR indicates cytogenetic response (includes complete, partial, minimal, and minor response when available); LBC, lymphoid blast crisis; NA, not available; MBC, myeloid blast crisis; bid, twice a day; and qd, daily.


The author thanks colleagues A. Hochhaus, M. C. Müller, S. Sauβele, M. Baccarani, and R. S. Silver for reading the manuscript; A. Gratwohl, R. Schwerdtfeger, and H.-J. Kolb for advice on transplantation in blast crisis; G. Bartsch and U. Böhm for technical support; and all members of the German CML Study Group for their continued patient care and cooperation.


That day was the beginning of a bloody crisis for Burundi, marked by serious human rights violations, committed in most part by Burundian security forces by order of the authorities. One year later, the toll of the repression appears to have reached at least 700 people killed, 4300 detained, 800 disappeared, hundreds of people tortured, dozens of women victim of sexual violence, and thousands of arrests. 250 000 Burundians have already fled the country.


One year on, our organisations compile here in a dossier the conclusions of their investigations and call on the international community to act immediately to stop the deadly circle of violence and to prevent mass atrocities. FIDH and ITEKA also pay tribute to all victims of the crisis.


Therefore all governments should have some kind of emergency plan for situations leading to blood shortage. The solution can be designed jointly for civilian and military medical services, or separately. The aim of this article is to describe the system of blood crisis policy in the Czech Republic.


The aim is to guarantee a sufficient and efficient supply of blood products and blood derivates in any place in the country during a crisis situation. In an extreme situation, such as war in the Czech territory, it is estimated that casualties of 2% would demand 3000 units RBCs / day.


An important part of the system is the transport of blood components during crisis situations. BCCs are responsible for transport and distribution of blood products and may seek assistance with transport coordination from the Ministry of Health. The BCCs are required to keep at least 200 RBCs and 200 plasma units and 20g of fibrinogen at a permanent disposal for the national crisis policy program. CILC collects up-to-date information from each BCC about available blood and plasma units. This information is updated daily every morning. In addition, BCCs must have emergency stocks for blood collection (blood bags, tubes) and for blood testing (2000 - 2500 sets), depending on the size of the area covered by the BCC.


A blood bank with frozen blood, located in the Central Military Hospital Prague, plays a special role in the Czech crisis policy; it is designed for 3000 units of frozen red cells (group 0). The closed system Haemonetics APC-215 is used, red cells, frozen in 40% glycerol, are stored in -65C in mechanical freezers and their shelf life after reconstitution in solution AS-3 (Nutricel) is 21 days. The military blood bank can provide a blood supply during any crisis in three forms: 1. common (liquid) RBCs (0 neg.) which are available in stock, 2. thawed (reconstituted) red cells (0 neg./pos.), 3. fresh, newly collected red cells. Eight pieces of Haemonetics ACP-215 machines render a theoretical capacity of 96 reconstituted frozen red cell units per 24 hour. 350c69d7ab


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