More than 1 million apheresis platelet collections are performed annually in the United States. After 2 healthy plateletpheresis donors were incidentally found to have low CD4+ T-lymphocyte counts, we investigated whether plateletpheresis causes lymphopenia. We conducted a cross-sectional single-center study of platelet donors undergoing plateletpheresis with the Trima Accel, which removes leukocytes continuously with its leukoreduction system chamber. We recruited 3 groups of platelet donors based on the total number of plateletpheresis sessions in the prior 365 days: 1 or 2, 3 to 19, or 20 to 24. CD4+ T-lymphocyte counts were <200 cells per microliter in 0/20, 2/20, and 6/20 donors, respectively (P = .019), and CD8+ T-lymphocyte counts were low in 0/20, 4/20, and 11/20 donors, respectively (P < .001). The leukoreduction system chamber’s lymphocyte-extraction efficiency was ∼15% to 20% for all groups. Immunophenotyping showed decreases in naive CD4+ T-lymphocyte and T helper 17 (Th17) cell percentages, increases in CD4+ and CD8+ effector memory, Th1, and regulatory T cell percentages, and stable naive CD8+ and Th2 percentages across groups. T-cell receptor repertoire analyses showed similar clonal diversity in all groups. Donor screening questionnaires supported the good health of the donors, who tested negative at each donation for multiple pathogens, including HIV. Frequent plateletpheresis utilizing a leukoreduction system chamber is associated with CD4+ and CD8+ T-cell lymphopenia in healthy platelet donors. The mechanism may be repeated extraction of these cells during plateletpheresis. The cytopenias do not appear to be harmful.

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Background Despite significant gains in the treatment of Human Immunodeficiency Virus (HIV), there are still over 38,000 newly diagnosed with the illness annually in the United States. One strategy to reduce HIV infections is Pre-Exposure Prophylaxis (PrEP) for HIV infection. PrEP involves daily oral emtricitabine/tenofovir disoproxil fumarate (FTC/TDF or Truvada®) to reduce infections in those with exposure(s) to HIV or high-risk groups. Studies have shown reduction in HIV transmission with PrEP treatment. The objective of the study is to investigate how behavioral, demographic, and socioeconomic status (SES) influences the awareness of PrEP treatment in NYC. Methods Data on economic, behavioral, PrEP awareness at the UHF neighborhood level was collected by the Community Health Survey (CHS) from the New York City Department of Health and Mental Hygiene and the American Community Survey from the U.S. Census. The population is a cross-sectional telephone survey of NYC residents with landlines and mobile phones for 2016 and 2017. Household income and neighborhood poverty level were used as proxies for SES. Sex-stratified, multivariate logistic regression model was constructed to estimate adjusted associations and determine differences in awareness of PrEP. The model controlled for age group, race, education level, men sex with men status (MSM), and having had an HIV test in the preceding 12 months. Results The final study sample was 5,515 and 5,761 in 2016 and 2017, respectively. In 2016 crude PrEP awareness rate was 24.3% and in 2017 it was 35.4%. In the multivariate analysis for both 2016 and 2017, PrEP awareness was independently associated with age group, education level, male MSM, and having had an HIV test in the preceding 12 months (p < 0.01). The strongest predictors of PrEP awareness were participants with a preceding HIV test in the past 12 months and males who are MSM. PrEP awareness was associated with race for males in 2016 and 2017. PrEP awareness was associated with race for women in 2016, but not 2017. Figure 1: (left) Median household income in NYC (right) HIV diagnoses and PrEP awareness for 2016 and 2017 Conclusion Understanding the relationship of neighborhood socioeconomic status and PrEP awareness is essential for HIV epidemiology. By monitoring PrEP awareness, HIV diagnoses, and risk factors associated with the two, public health officials better target interventions and health policy. Disclosures All Authors: No reported disclosures

Lung cancer is the second most diagnosed cancer in the United States and the leading cause of cancer death. Small-cell lung cancer (SCLC) represents about 15% of all lung cancers and is marked by an exceptionally high proliferative rate, strong predilection for early metastasis and poor prognosis. SCLC is strongly associated with exposure to tobacco carcinogens. The presentation of small cell lung cancer is non-specific. Patients can present with rapid-onset symptoms due to local intrathoracic tumor growth, extrapulmonary distant spread, paraneoplastic syndromes, or a combination of these features. While small cell cancer is well known as a rapidly growing cancer, rarely does it present encompassing a whole lung. CASE PRESENTATION:A 46-year-old male who presented with a one month history of productive cough, fatigue, anorexia with 8lbs weight loss, back pain, and palpitations. He had a 20-pack year smoking history. Examination was significant for tachycardia, elevated blood pressure, right sided facial puffiness with engorged distended veins on the neck, anterior chest wall and abdomen. There were absent breath sounds on the right upper and middle lung zones. Supraclavicular and axillary lymphadenopathy were noted. Chest x-ray done showed Complete opacification of the right upper and middle lobes consistent with lung mass . Chest CT showed Large mass within the right upper lobe measures approximately 18.2 x 13.4 x 17.1 cm with mass effect noted on mediastinal structures which are shifted to the left. The mass encased the right mainstem bronchus, right main pulmonary artery with obstruction at the medial to distal aspect of the artery, and compression of the superior vena cava with collateral circulation within the right chest wall and venous drainage through the azygos vein into the inferior vena cava. Lymph node biopsy was done which showed poorly differentiated neuroendocrine carcinoma, favoring small cell type. He was subsequently referred for treatment.DISCUSSION: SCLC is a cancer of neuroendocrine origin, characterized by rapid growth with significant mediastinal adenopathy. Common clinical symptoms are non-specific and sometimes may present with compressive symptoms such superior vena cava syndrome. Here we present a case of a huge SCLC with SVC syndrome presenting only after a short duration of symptoms in a former smoker. Cigarette smoking remains a major culprit and smoking cessation is one of the most important primary preventive measures.CONCLUSIONS: SCLC remains one of the most common causes of cancer death in the United States. The challenge with the diagnosis and management of SCLC continues to be the rapidity of growth and non-specific symptomatology, and as a result most patients present late. Therefore clinicians need to have a high index of suspicion especially in current and past tobacco smokers in order to ensure early diagnosis and prompt intervention.