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BACKGROUND The first coronavirus (COVID‐19) case was reported in United States in the state of Washington, approximately 3 months after the outbreak in Wuhan, China. Three weeks later, the US federal government declared the pandemic a national emergency. The number of confirmed COVID‐19 positive cases increased rather rapidly and changed routine daily activities of the community. STUDY DESIGN AND METHODS This brief report describes the response from the hospital, the regional blood center, and the hospital‐based transfusion services to the events that took place in the community during the initial phases of the pandemic. RESULTS In Washington State, the first week of March started with four confirmed cases and ended with 150; by the end of the second week of March there were more than 700 cases of confirmed COVID‐19. During the first week, blood donations dropped significantly. Blood units provided from blood centers of nonaffected areas of the country helped keep inventory stable and allow for routine hospital operations. The hospital‐based transfusion service began prospective triaging of blood orders to monitor and prioritize blood usage. In the second week, blood donations recovered, and the hospital postponed elective procedures to ensure staff and personal protective equipment were appropriate for the care of critical patients. CONCLUSION As community activities are disrupted and hospital activities switch from routine operations to pandemic focused and urgent care oriented, the blood supply and usage requires a number of transformations.

Immune-mediated thrombotic thrombocytopenic purpura is characterized by severe thrombocytopenia and microangiopathic hemolytic anemia. It is primarily caused by immunoglobin G type autoantibodies against ADAMTS13, a plasma metalloprotease that cleaves von Willebrand factor. However, reliable markers predictive of patient outcomes are yet to be identified. Seventy-three unique patients with a confirmed diagnosis of immune-mediated thrombotic thrombocytopenic purpura between April 2006 and December 2017 were enrolled from the Univeristy of Alabama at Birmingham Medical Center. Clinical information, laboratory values, and a panel of special biomarkers were collected and/or determined. The results demonstrated that the biomarkers associated with endothelial injury (e.g. von Willebrand factor antigen and collagen-binding activity), acute inflammation (e.g. human neutrophil peptides 1-3 and histone/deoxyribonucleic acid complexes), and activation of the complement alternative pathway (e.g. factors Bb and iC3b) were all significantly increased in patients with acute immune-mediated thrombotic thrombocytopenic purpura compared to those in the healthy controls who did not have a hematological disease; moreover, failure to normalize platelet counts within 7 days or failure to markedly reduce serum lactate dehydrogenase by day 5, low total serum protein or albumin, and high serum troponin levels were also predictive of mortality; so were the prolonged activated partial thromboplastin time, high fibrinogen, and elevated serum lactate dehydrogenase, Bb, and sC5b-9 on admission. These results may help to stratify patients for more intensive management; the findings may also provide a framework for future multicenter studies to identify valuable prognostic markers for immune-mediated thrombotic thrombocytopenic purpura.

Objectives Therapy with broad-spectrum antibiotics is a common practice for premature infants. This treatment can reduce the biodiversity of the fecal microbiota and may be a factor in the cause of necrotizing enterocolitis (NEC). In contrast, probiotic treatment of premature infants reduces the incidence of NEC. We hypothesized that one mechanism for these observations is the influence of bacteria on postnatal development of the mucosal immune system. Methods Expression of immune molecules and microbial sensors was investigated in the postnatal mouse gastrointestinal tract by real-time PCR. Subsequently, two-week-old specific pathogen free (SPF) and microbial reduced (antibiotic treated, MR) mice were compared for immune molecule and microbial sensor expression, mesenteric lymph node (MLN) T-cell numbers and activation, intestinal barrier function/permeability, systemic lymphocyte numbers, and T-cell phenotype commitment. Results Toll-like receptor (TLR) 2, 4, and 5 expression was highest in 2-week-old SPF mice, and this expression was decreased in MR mice. There was no difference in intestinal tight-junctional function, as evaluated by FITC-dextran uptake, but MR mice had increased bacteria translocation across the intestinal epithelial barrier. MR mice had significantly fewer splenic B-cells and MLN CD4+ T-cells, but there were normal numbers of splenic T-cells. These systemic T-cells from MR mice produced more IL-4, and less interferon-γ and IL-17, indicative of a maintenance of the fetal, T-helper cell type 2 phenotype. Conclusions This study shows that intestinal commensal microbiota have an influence on early postnatal immune development. Determining specific bacteria and/or bacterial ligands critical for this development could provide insight into the mechanisms by which broad-spectrum antibiotics and/or probiotic therapy influences the development of the mucosal immune system and mucosal-related diseases.

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