BACKGROUNDThe popularity of Low-Titer O Whole Blood (LTOWB) for treating trauma patients requires that donor centers and transfusion services make decisions on what titer testing capabilities to institute and an appropriate titer level threshold. This study compared the titer results determined by four methods to find a rate of agreement.STUDY DESIGN AND METHODSIsohemagglutinin titers were tested on 300 plasma samples utilizing various methods, each determining IgM antibody levels by direct hemagglutination with A1 and B reference cells. The methods used were the Beckman Coulter's PK7300, Immucor's NEO Iris microplate technology, Ortho Clinical Diagnostics (OCD) Vision, and manual titrations.RESULTSOnly 42.7% of the samples tested showed agreement across all methods on ABO isohemaglutinin titer levels and only 32.5% demonstrated "High titer" agreement. Sample agreement was close to 90% if the Immucor method was excluded. At a <1:256 titer level threshold, the pass rate was 94.3% for Immucor, 89.7% for the PK7300, 87.3% for manual testing, and 75.7% for OCD's gel method. Sensitivity and specificity rates at a ± 1 titer level were respectively 100% and 95.4% for OCD's gel, 73.7% and 100% for Immucor, and 100% and 99.6% for the PK7300. Overall method accuracy was 91.7% for Immucor, 90.3% for the PK7300, and 86.7% for OCD's gel method as compared to manual titration.CONCLUSIONAll three automated methods perform comparably to the manual method at a ± 1 titer tolerance level. Based on these comparisons, a titer level of <1:256 would maximize LTOWB production regardless of the method used.
{"title":"Comparison of manual titrations to automated microplate and gel titration assays used in the screening of blood donors for production of Low-Titer O Whole Blood.","authors":"Michael D Orr,Brian G Casleton,Olivia R Garcia","doi":"10.1111/trf.17953","DOIUrl":"https://doi.org/10.1111/trf.17953","url":null,"abstract":"BACKGROUNDThe popularity of Low-Titer O Whole Blood (LTOWB) for treating trauma patients requires that donor centers and transfusion services make decisions on what titer testing capabilities to institute and an appropriate titer level threshold. This study compared the titer results determined by four methods to find a rate of agreement.STUDY DESIGN AND METHODSIsohemagglutinin titers were tested on 300 plasma samples utilizing various methods, each determining IgM antibody levels by direct hemagglutination with A1 and B reference cells. The methods used were the Beckman Coulter's PK7300, Immucor's NEO Iris microplate technology, Ortho Clinical Diagnostics (OCD) Vision, and manual titrations.RESULTSOnly 42.7% of the samples tested showed agreement across all methods on ABO isohemaglutinin titer levels and only 32.5% demonstrated \"High titer\" agreement. Sample agreement was close to 90% if the Immucor method was excluded. At a <1:256 titer level threshold, the pass rate was 94.3% for Immucor, 89.7% for the PK7300, 87.3% for manual testing, and 75.7% for OCD's gel method. Sensitivity and specificity rates at a ± 1 titer level were respectively 100% and 95.4% for OCD's gel, 73.7% and 100% for Immucor, and 100% and 99.6% for the PK7300. Overall method accuracy was 91.7% for Immucor, 90.3% for the PK7300, and 86.7% for OCD's gel method as compared to manual titration.CONCLUSIONAll three automated methods perform comparably to the manual method at a ± 1 titer tolerance level. Based on these comparisons, a titer level of <1:256 would maximize LTOWB production regardless of the method used.","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248310","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gaganvir Parmar,Meagan Green,Kathy Ganz,Matthew D Seftel,David S Allan
BACKGROUNDAllogeneic hematopoietic cell transplantation remains limited when stem cell registrants cannot be contacted, are not medically fit, are unavailable, or unwilling to proceed. In a recent report, registrants who were prior blood donors were more likely to be available for donation. In this study, we analyzed extent to which recruiting blood donors to the Canadian Blood Services Stem Cell Registry (CBS SCR) can meet targets for ethnic diversity, age, and proximity to collection facilities.METHODS AND RESULTSWe analyzed 124,496 active blood donors on July 1, 2023 regarding the criteria for recruitment to the CBS SCR. A total of 40,518 (32%) were younger than 36 years of age and 49% were first-time donors (potential new recruits year over year). The ethnicity of blood donors younger than 36 years aligns more closely with the 2021 Canadian census compared to stem cell donors who were also previous blood donors, and to the current total inventory of all registrants on the CBS SCR. Of the blood donors, certain ethnic groups, including Black, Chinese, and First Nations/Indigenous, remain underrepresented. A greater proportion of active whole blood donors live within 400 km of a stem cell collection center (91%) compared to stem cell donors who donated during the past 10 years (80%).CONCLUSIONSRecruitment of blood donors offers an opportunity to improve the ethnic diversity of the CBS SCR and increase proximity of registrants to stem cell collection centers. The potential improved availability of registrants when matched to patients requires confirmation.
{"title":"Recruiting blood donors to the Canadian Blood Services Stem Cell Registry: A feasibility assessment.","authors":"Gaganvir Parmar,Meagan Green,Kathy Ganz,Matthew D Seftel,David S Allan","doi":"10.1111/trf.18016","DOIUrl":"https://doi.org/10.1111/trf.18016","url":null,"abstract":"BACKGROUNDAllogeneic hematopoietic cell transplantation remains limited when stem cell registrants cannot be contacted, are not medically fit, are unavailable, or unwilling to proceed. In a recent report, registrants who were prior blood donors were more likely to be available for donation. In this study, we analyzed extent to which recruiting blood donors to the Canadian Blood Services Stem Cell Registry (CBS SCR) can meet targets for ethnic diversity, age, and proximity to collection facilities.METHODS AND RESULTSWe analyzed 124,496 active blood donors on July 1, 2023 regarding the criteria for recruitment to the CBS SCR. A total of 40,518 (32%) were younger than 36 years of age and 49% were first-time donors (potential new recruits year over year). The ethnicity of blood donors younger than 36 years aligns more closely with the 2021 Canadian census compared to stem cell donors who were also previous blood donors, and to the current total inventory of all registrants on the CBS SCR. Of the blood donors, certain ethnic groups, including Black, Chinese, and First Nations/Indigenous, remain underrepresented. A greater proportion of active whole blood donors live within 400 km of a stem cell collection center (91%) compared to stem cell donors who donated during the past 10 years (80%).CONCLUSIONSRecruitment of blood donors offers an opportunity to improve the ethnic diversity of the CBS SCR and increase proximity of registrants to stem cell collection centers. The potential improved availability of registrants when matched to patients requires confirmation.","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
BackgroundDespite several reports on red blood cell (RBC) alloimmunization, the actual prevalence and factors contributing to RBC alloimmunization in transfused patients remain poorly investigated. We examined the association between clinical factors and the development and evanescence of RBC antibodies after transfusion.Study Design and MethodsEach participating institution performed antibody screens before and after RBC transfusion. A survey including patient characteristics, results of antibody screen and identification, antibody screen methods, total amount of RBC transfused, and adverse reactions, was conducted.ResultsBetween October 2018 and March 2023, 1194 patients were registered at five institutions. Overall, 958 patients underwent at least one follow‐up RBC antibody screen after transfusion, revealing new antibody development in 44 (4.6%). Anti‐E was identified in 25 patients, anti‐Jka in 5, and anti‐c in 4. The number of RBC units transfused was significantly associated with antibody development after transfusion (p < .001). Among 55 patients in whom antibodies were identified after transfusion, including historical antibodies, antibodies evanesced in 18 (33%); anti‐E in 7, anti‐Jka in 4, and anti‐Lea in 2. Evanescent antibodies were identified more frequently by saline and/or enzyme methods than persistent antibodies (p = .012).DiscussionThe number of RBC units transfused can impact antibody development, and antibodies identified only by saline and/or enzyme methods, deemed clinically insignificant, are likely to have a high evanescence rate. Antibody screen should be carefully performed, especially in those receiving a large number of RBC units. Confirming previous antibody screen results should be performed to prevent omitting evanesced antibodies regardless of clinical relevance.
{"title":"The development and evanescence of red blood cell antibodies after transfusion: A multi‐institutional prospective study in Japan","authors":"Chiaki Yamada, Takaaki Ono, Kaede Ino, Naoki Nemoto, Takahito Shinba, Hiroaki Furumaki, Hiroki Shibata, Keiko Ishizuka, Naotomo Yamada, Hideaki Matsuura, Yumiko Izuhara, Harumi Fujihara, Hitoshi Minamiguchi","doi":"10.1111/trf.18009","DOIUrl":"https://doi.org/10.1111/trf.18009","url":null,"abstract":"BackgroundDespite several reports on red blood cell (RBC) alloimmunization, the actual prevalence and factors contributing to RBC alloimmunization in transfused patients remain poorly investigated. We examined the association between clinical factors and the development and evanescence of RBC antibodies after transfusion.Study Design and MethodsEach participating institution performed antibody screens before and after RBC transfusion. A survey including patient characteristics, results of antibody screen and identification, antibody screen methods, total amount of RBC transfused, and adverse reactions, was conducted.ResultsBetween October 2018 and March 2023, 1194 patients were registered at five institutions. Overall, 958 patients underwent at least one follow‐up RBC antibody screen after transfusion, revealing new antibody development in 44 (4.6%). Anti‐E was identified in 25 patients, anti‐Jk<jats:sup>a</jats:sup> in 5, and anti‐c in 4. The number of RBC units transfused was significantly associated with antibody development after transfusion (<jats:italic>p</jats:italic> < .001). Among 55 patients in whom antibodies were identified after transfusion, including historical antibodies, antibodies evanesced in 18 (33%); anti‐E in 7, anti‐Jk<jats:sup>a</jats:sup> in 4, and anti‐Le<jats:sup>a</jats:sup> in 2. Evanescent antibodies were identified more frequently by saline and/or enzyme methods than persistent antibodies (<jats:italic>p</jats:italic> = .012).DiscussionThe number of RBC units transfused can impact antibody development, and antibodies identified only by saline and/or enzyme methods, deemed clinically insignificant, are likely to have a high evanescence rate. Antibody screen should be carefully performed, especially in those receiving a large number of RBC units. Confirming previous antibody screen results should be performed to prevent omitting evanesced antibodies regardless of clinical relevance.","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Massimo Griselli, Sameh M. Said, Philip C. Spinella, Michael Evans, Claudia S. Cohn, Nitasha Joyner, Martina Richtsfeld, Kayla Fahey‐Arndt, Julie Welbig, Greg Beilman, Nicole D. Zantek, Marie E. Steiner
BackgroundLow titer group O whole blood (LTOWB) is commonly used for severe bleeding in trauma patients. LTOWB may also benefit young children requiring cardiac surgery with cardiopulmonary bypass (CPB) at risk of severe bleeding.Study Design and MethodsIn this retrospective study, children <2 years old who underwent cardiac surgery with CPB were included. Comparisons were performed between those receiving component therapy (CT) versus those receiving LTOWB plus CT (LTOWB+CT). Outcomes included drainage tube (DT) output and total transfusion volumes. Optimization‐based weighting was used for adjusted analyses between groups.ResultsThere were 117 patients transfused with only CT and 127 patients transfused with LTOWB+CT. In the LTOWB+CT group, 66 were Group non‐O and 61 were Group O. Total transfusion volumes given from the start of the operation until the first 24 h in the cardiac intensive care unit was a median (IQR) 41 (10, 93) mL/kg in the CT group and 48 (28, 77) mL/kg in the LTOWB+CT group, (p = .28). Median (IQR) DT output was 22 (15–32) in CT versus 22 (16–28) in LTOWB+CT groups, (p = .27). There were no differences in death, renal failure and a composite of death and renal failure between the two groups, but there were statistically fewer re‐explorations for bleeding in the LTOWB+CT group (p < .001).ConclusionsThe use of LTOWB appears to be safe in <2 years old undergoing cardiac surgery and may reduce re‐explorations for severe bleeding. Large trials are needed to determine the efficacy and safety of LTOWB in this population with severe bleeding.
{"title":"Use of low titer O whole blood in infants and young children undergoing cardiac surgery with cardiopulmonary bypass","authors":"Massimo Griselli, Sameh M. Said, Philip C. Spinella, Michael Evans, Claudia S. Cohn, Nitasha Joyner, Martina Richtsfeld, Kayla Fahey‐Arndt, Julie Welbig, Greg Beilman, Nicole D. Zantek, Marie E. Steiner","doi":"10.1111/trf.18014","DOIUrl":"https://doi.org/10.1111/trf.18014","url":null,"abstract":"BackgroundLow titer group O whole blood (LTOWB) is commonly used for severe bleeding in trauma patients. LTOWB may also benefit young children requiring cardiac surgery with cardiopulmonary bypass (CPB) at risk of severe bleeding.Study Design and MethodsIn this retrospective study, children <2 years old who underwent cardiac surgery with CPB were included. Comparisons were performed between those receiving component therapy (CT) versus those receiving LTOWB plus CT (LTOWB+CT). Outcomes included drainage tube (DT) output and total transfusion volumes. Optimization‐based weighting was used for adjusted analyses between groups.ResultsThere were 117 patients transfused with only CT and 127 patients transfused with LTOWB+CT. In the LTOWB+CT group, 66 were Group non‐O and 61 were Group O. Total transfusion volumes given from the start of the operation until the first 24 h in the cardiac intensive care unit was a median (IQR) 41 (10, 93) mL/kg in the CT group and 48 (28, 77) mL/kg in the LTOWB+CT group, (<jats:italic>p</jats:italic> = .28). Median (IQR) DT output was 22 (15–32) in CT versus 22 (16–28) in LTOWB+CT groups, (<jats:italic>p</jats:italic> = .27). There were no differences in death, renal failure and a composite of death and renal failure between the two groups, but there were statistically fewer re‐explorations for bleeding in the LTOWB+CT group (<jats:italic>p</jats:italic> < .001).ConclusionsThe use of LTOWB appears to be safe in <2 years old undergoing cardiac surgery and may reduce re‐explorations for severe bleeding. Large trials are needed to determine the efficacy and safety of LTOWB in this population with severe bleeding.","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Camous Moslemi, Susanne Sækmose, Rune Larsen, Thorsten Brodersen, Jakob T. Bay, Maria Didriksen, Kaspar R. Nielsen, Mie T. Bruun, Joseph Dowsett, Khoa M. Dinh, Christina Mikkelsen, Kati Hyvärinen, Jarmo Ritari, Jukka Partanen, Henrik Ullum, Christian Erikstrup, Sisse R. Ostrowski, Martin L. Olsson, Ole B. Pedersen
BackgroundDeep learning methods are revolutionizing natural science. In this study, we aim to apply such techniques to develop blood type prediction models based on cheap to analyze and easily scalable screening array genotyping platforms.MethodsCombining existing blood types from blood banks and imputed screening array genotypes for ~111,000 Danish and 1168 Finnish blood donors, we used deep learning techniques to train and validate blood type prediction models for 36 antigens in 15 blood group systems. To account for missing genotypes a denoising autoencoder initial step was utilized, followed by a convolutional neural network blood type classifier.ResultsTwo thirds of the trained blood type prediction models demonstrated an F1‐accuracy above 99%. Models for antigens with low or high frequencies like, for example, Cw, low training cohorts like, for example, Cob, or very complicated genetic underpinning like, for example, RhD, proved to be more challenging for high accuracy (>99%) DL modeling. However, in the Danish cohort only 4 out of 36 models (Cob, Cw, D‐weak, Kpa) failed to achieve a prediction F1‐accuracy above 97%. This high predictive performance was replicated in the Finnish cohort.DiscussionHigh accuracy in a variety of blood groups proves viability of deep learning‐based blood type prediction using array chip genotypes, even in blood groups with nontrivial genetic underpinnings. These techniques are suitable for aiding in identifying blood donors with rare blood types by greatly narrowing down the potential pool of candidate donors before clinical grade confirmation.
{"title":"A deep learning approach to prediction of blood group antigens from genomic data","authors":"Camous Moslemi, Susanne Sækmose, Rune Larsen, Thorsten Brodersen, Jakob T. Bay, Maria Didriksen, Kaspar R. Nielsen, Mie T. Bruun, Joseph Dowsett, Khoa M. Dinh, Christina Mikkelsen, Kati Hyvärinen, Jarmo Ritari, Jukka Partanen, Henrik Ullum, Christian Erikstrup, Sisse R. Ostrowski, Martin L. Olsson, Ole B. Pedersen","doi":"10.1111/trf.18013","DOIUrl":"https://doi.org/10.1111/trf.18013","url":null,"abstract":"BackgroundDeep learning methods are revolutionizing natural science. In this study, we aim to apply such techniques to develop blood type prediction models based on cheap to analyze and easily scalable screening array genotyping platforms.MethodsCombining existing blood types from blood banks and imputed screening array genotypes for ~111,000 Danish and 1168 Finnish blood donors, we used deep learning techniques to train and validate blood type prediction models for 36 antigens in 15 blood group systems. To account for missing genotypes a denoising autoencoder initial step was utilized, followed by a convolutional neural network blood type classifier.ResultsTwo thirds of the trained blood type prediction models demonstrated an F1‐accuracy above 99%. Models for antigens with low or high frequencies like, for example, C<jats:sup>w</jats:sup>, low training cohorts like, for example, Co<jats:sup>b</jats:sup>, or very complicated genetic underpinning like, for example, RhD, proved to be more challenging for high accuracy (>99%) DL modeling. However, in the Danish cohort only 4 out of 36 models (Co<jats:sup>b</jats:sup>, C<jats:sup>w</jats:sup>, D‐weak, Kp<jats:sup>a</jats:sup>) failed to achieve a prediction F1‐accuracy above 97%. This high predictive performance was replicated in the Finnish cohort.DiscussionHigh accuracy in a variety of blood groups proves viability of deep learning‐based blood type prediction using array chip genotypes, even in blood groups with nontrivial genetic underpinnings. These techniques are suitable for aiding in identifying blood donors with rare blood types by greatly narrowing down the potential pool of candidate donors before clinical grade confirmation.","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142248313","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Masthead and Table of Contents","authors":"","doi":"10.1111/trf.17440","DOIUrl":"https://doi.org/10.1111/trf.17440","url":null,"abstract":"","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mayank Soni, Shubhank Goyal, Narendra Agrawal, Tribikram Panda
{"title":"Anti‐donor antibody neutralization by donor type red cell challenge: A novel therapeutic strategy in refractory post‐transplant pure red cell aplasia","authors":"Mayank Soni, Shubhank Goyal, Narendra Agrawal, Tribikram Panda","doi":"10.1111/trf.17936","DOIUrl":"https://doi.org/10.1111/trf.17936","url":null,"abstract":"","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142223757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Denise Brunetta, Lhais Helenne Santos, Tie Costa, Francisca Lariza Moura, Josiana Cruz, Nagela Oliveira, Maria Isaaquilelle Oliveira, Claudia Monteiro, Franklin Jose Santos, Luciana Maria Carlos
{"title":"Building a local rare blood registry from scratch: A success story","authors":"Denise Brunetta, Lhais Helenne Santos, Tie Costa, Francisca Lariza Moura, Josiana Cruz, Nagela Oliveira, Maria Isaaquilelle Oliveira, Claudia Monteiro, Franklin Jose Santos, Luciana Maria Carlos","doi":"10.1111/trf.17961","DOIUrl":"https://doi.org/10.1111/trf.17961","url":null,"abstract":"","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Continuing Medical Education","authors":"","doi":"10.1111/trf.17980","DOIUrl":"https://doi.org/10.1111/trf.17980","url":null,"abstract":"","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":null,"pages":null},"PeriodicalIF":2.9,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142181272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jeremy W Jacobs, Garrett S Booth, Kenneth J Moise, Brian D Adkins, Sara Bakhtary, Ross M Fasano, Ruchika Goel, Hannah D Hinton, Sadia A Laghari, Laura D Stephens, Christopher A Tormey, Elizabeth P Crowe, Evan M Bloch, Elizabeth A Abels
Background: Hemolytic disease of the fetus and newborn (HDFN) is caused by maternal alloantibody-mediated destruction of fetal/neonatal red blood cells (RBCs). While the pathophysiology has been well-characterized, the clinical and laboratory monitoring practices are inconsistent.
Methods: We surveyed 103 US institutions to characterize laboratory testing practices for individuals with fetuses at risk of HDFN. Questions included antibody testing and titration methodologies, the use of critical titers, paternal and cell-free fetal DNA testing, and result reporting and documentation practices.
Results: The response rate was 44% (45/103). Most respondents (96%, 43/45) assess maternal antibody titers, primarily using conventional tube-based methods only (79%, 34/43). Among respondents, 51% (23/45) rescreen all individuals for antibodies in the third trimester, and 60% (27/45) perform paternal RBC antigen testing. A minority (27%, 12/45) utilize cell-free fetal DNA (cffDNA) testing to predict fetal antigen status. Maternal antibody titers are performed even when the fetus is not considered to be at risk of HDFN based on cffDNA or paternal RBC antigen testing at 23% (10/43) of sites that assess titers.
Discussion: There is heterogeneity across US institutions regarding the testing, monitoring, and reporting practices for pregnant individuals with fetuses at risk of HDFN, including the use of antibody titers in screening and monitoring programs, the use of paternal RBC antigen testing and cffDNA, and documentation of fetal antigen results. Standardization of laboratory testing protocols and closer collaboration between the blood bank and transfusion medicine service and the obstetric/maternal-fetal medicine service are needed.
{"title":"Characterization of blood bank and transfusion medicine practices for pregnant individuals with fetuses at risk of hemolytic disease in the United States.","authors":"Jeremy W Jacobs, Garrett S Booth, Kenneth J Moise, Brian D Adkins, Sara Bakhtary, Ross M Fasano, Ruchika Goel, Hannah D Hinton, Sadia A Laghari, Laura D Stephens, Christopher A Tormey, Elizabeth P Crowe, Evan M Bloch, Elizabeth A Abels","doi":"10.1111/trf.18011","DOIUrl":"https://doi.org/10.1111/trf.18011","url":null,"abstract":"<p><strong>Background: </strong>Hemolytic disease of the fetus and newborn (HDFN) is caused by maternal alloantibody-mediated destruction of fetal/neonatal red blood cells (RBCs). While the pathophysiology has been well-characterized, the clinical and laboratory monitoring practices are inconsistent.</p><p><strong>Methods: </strong>We surveyed 103 US institutions to characterize laboratory testing practices for individuals with fetuses at risk of HDFN. Questions included antibody testing and titration methodologies, the use of critical titers, paternal and cell-free fetal DNA testing, and result reporting and documentation practices.</p><p><strong>Results: </strong>The response rate was 44% (45/103). Most respondents (96%, 43/45) assess maternal antibody titers, primarily using conventional tube-based methods only (79%, 34/43). Among respondents, 51% (23/45) rescreen all individuals for antibodies in the third trimester, and 60% (27/45) perform paternal RBC antigen testing. A minority (27%, 12/45) utilize cell-free fetal DNA (cffDNA) testing to predict fetal antigen status. Maternal antibody titers are performed even when the fetus is not considered to be at risk of HDFN based on cffDNA or paternal RBC antigen testing at 23% (10/43) of sites that assess titers.</p><p><strong>Discussion: </strong>There is heterogeneity across US institutions regarding the testing, monitoring, and reporting practices for pregnant individuals with fetuses at risk of HDFN, including the use of antibody titers in screening and monitoring programs, the use of paternal RBC antigen testing and cffDNA, and documentation of fetal antigen results. Standardization of laboratory testing protocols and closer collaboration between the blood bank and transfusion medicine service and the obstetric/maternal-fetal medicine service are needed.</p>","PeriodicalId":23266,"journal":{"name":"Transfusion","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142155040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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