Transfusion最新文献

Background: We reviewed trauma blood use at our US regional trauma center 2011-2022-including PROPPR trial participation 2012-2014 and initiation of whole blood availability in 2019-to assess the implementation of early coagulation support in acute trauma care.

Study design/methods: We identified all acute trauma patients recorded by our Trauma Registry as arriving at our large US regional Level 1 trauma center from April 6, 2011 (Blood Bank opening) through December 2022. Patient cohort data were then linked directly to Blood Bank final-product-issue date/time data to identify patients receiving any blood product in the first 24 h of care and then, specifically, at least one unit of Red Blood Cells (RBC), Plasma, or Whole Blood (WB). Results were binned as: "RBC first," "Plasma first," "Both at the same time," or "WB first."

Results: Over the study period, 73,634 acute trauma patients received care, and 12,927 received at least one unit of a blood product. The proportion receiving plasma or a combination of plasma and RBCs as the initial transfusion increased after 2015 from 33% to 66%, while the proportion receiving packed RBCs alone decreased from 57% to about 18%. Since its introduction in 2019, the use of WB as the first product has grown to 20%.

Conclusions: This retrospective cohort study documents the increasing use of plasma and now WB as initial products issued in trauma resuscitation, reflecting acceptance of coagulation support as the standard of care and the use of hemostatic resuscitation protocols.

Background: Production of platelet concentrates (PCs) involves several steps that significantly affect platelet behavior. To gain a deeper understanding of how storage conditions impact donor platelet recirculation and functionality post-transfusion, ex vivo platelet labeling is a feasible approach. However, before pursuing clinical investigations of platelet recirculation and function in humans, we aimed to determine the effects of pathogen inactivation technology (PIT) and storage conditions (4°C vs. room temperature [RT]) on phenotype and function of biotinylated platelets compared to conventional PIT PCs for transfusion.

Methods: Nine PCs were prepared in 61% additive solution from 45 buffy coats (five buffy coats each). A pool-and-split of three units was used to prepare three equivalent PCs: two labeled with biotin and stored at RT or 4°C, and one without labeling and stored at RT. All PCs were then treated by PIT (amotosalen/UVA) and stored for 14 days. Labeling efficiency, platelet concentration, metabolic parameters, aggregation response (ADP, collagen, co-aggregation with epinephrine), and platelet phenotype (CD42b, CD62-P, phosphatidylserine) at the basal stage and upon stimulation (ADP or TRAP-6) were performed.

Results: Labeling efficiency of PIT and 4°C PCs was stable over 14 days of storage. Differences in platelet function and phenotype were mainly due to the storage temperature and not the biotinylation process. Phenotypes at baseline or after stimulation were equivalent in biotin-positive and biotin-negative platelets.

Conclusion: Biotin-labeled platelets can effectively enable investigation of the effects of PIT and storage temperature for clinical studies. This method shows great potential for improving platelet transfusion knowledge.

Background: Among the alleles of the ABO system, cisAB and B(A) are the most intriguing due to their ability to encode a glycosyltransferase that can synthesize both A and B antigens. This dual activity leads to the formation of the AB phenotype, even in the presence of the O allele; resolution is achieved by molecular analyses.

Case presentation and methods: We describe herein a Brazilian family in which the mother (M42.1) of group AB and the father (M42.2) of group O have two children of group AB (M42.3 and M42.4). Serological characterization involved ABO and H phenotyping tests and serial dilution of ABO monoclonal antibodies. Characterization of ABO genotypes and alleles were performed by PCR-RFLP and sequencing.

Results and discussion: In serological tests, red blood cells from M42.1, M42.3, and M42.4 showed an intermediate reactivity pattern between A₁B and A₂B. Molecular analyses revealed the presence of the ABO*O.01.01/O.01.01 genotype in M42.2 and the ABO*cisAB.05/O.01.01 genotype in M42.1, M42.3, and M42.4. The ABO*cisAB.05 allele encodes a glycosyltransferase able to synthesize A and B antigens in quantities sufficient to cause an agglutination reaction higher than that observed in A₂B phenotypes.

Conclusion: The combination of serological and molecular methods used in this study allowed us to determine the serological pattern, identify the ABO alleles, and explain the inheritance of the AB phenotype in this family.

Background: Pathogen reduction (PR) may be used as an alternative to gamma or x-ray irradiation (I) to prevent transfusion associated graft versus host disease (TA-GVHD) if the pathogen reduction technology has been shown to inactivate residual lymphocytes. However, as I is considered the gold standard for reducing the risk of TA-GVHD, some centers continue to perform I in addition to PR. This study investigated the effect of concurrent pathogen reduction and irradiation (PR/I) on the biochemical characteristics of apheresis platelets at day 1, 5, and 7 of storage at room temperature.

Methods: We compared in vitro characteristics of apheresis platelets (PLTs), PR PLTs, I PLTs, and PR/I PLTs at storage day 1, 5, and 7. PLTs from six healthy volunteers were suspended in 65% PAS-3/35% plasma prior to splitting and treatment with PR, I, or PR/I. Parameters measured were: PLT loss, mean PLT volume (MPV), pH, glucose consumption, lactate production, CD62P, annexin V binding, PLT aggregation, mitochondrial membrane potential (MMP), and reactive oxygen species (ROS).

Results: PR/I PLTs did not show significant changes in measured parameters when compared to PR PLTs. However, when compared to control PLTs, PR and PR/I PLTs showed significant declines in PLT content, pH, MMP, aggregation and significant increases in MPV, CD62P, annexin V binding, and ROS production, mostly on day 7 of storage. Irradiation did not cause significant changes in measured parameters in comparison to control PLTs.

Conclusions/summary: While PR impacts PLTs' biochemical characteristics and function, irradiation of PR PLTs did not cause additional significant changes.

Background: Evaluation of additive solutions, storage containers, new collection and storage methods, and other potential modifications is resource intensive, resulting in diversion of platelets away from blood bank inventories and significant time to complete study recruitments. Our goal was to evaluate the feasibility of a small bag for the study of platelet storage, and, by using a standardized respirometry test, separate daily metabolic capacity from observations made in the dynamic storage environment of changing pH, fuels, and end products.

Methods: Single-donor apheresis platelets collected in 100% plasma had small volumes removed to meet secondary processing requirements. Small volumes (23 ± 1.4 mL) were placed in 50-mL bags constructed of platelet storage material, stored 7 days, and assessed with a panel of in vitro assays. Platelet bioenergetics (oxygen consumption and acid production rates) were measured with a respirometer.

Results: The patterns of platelet pH decline, activation, and potency by thrombin generation were consistent with historical reports. Lactate production rates (54.1 ± 11.3 μmol/10¹²plt/h) were significantly correlated with pH decrease, increased activation, and thrombin generation potency by Day 7. Respirometry revealed a reduction of the glycolytic capacity and accumulating damage to the oxidative system for ATP production over storage.

Discussion: Small bags present a storage profile of metabolic changes and activation consistent with historical data for full bag storage. Therefore, this system has promise to provide a platform for scaling experiments of platelet storage in a manner that maximizes platelets collected in research settings and does not compromise availability for patient treatment as exercised in this study.

Background: Storage of platelets as platelet concentrates for transfusion is limited to 7 days in the United Kingdom due to deleterious effects on platelet quality and function that occur over time. Oxygen (O₂) availability and sufficient gaseous exchange are known to be essential in maintaining the viability and function of platelets stored for transfusion. Despite this, there is a paucity of studies undertaking direct measures of O₂ and optimization of conditions throughout storage. We address this and modulate the storage conditions to improve platelet quality and function.

Study design and methods: Electron paramagnetic resonance oximetry was implemented to directly measure the [O₂] experienced by stored platelet concentrates and the O₂ consumption rate under standard blood banking conditions. From these direct measures the mathematical modeling was then applied to predict the main parameters contributing to effective O₂ distribution throughout the unit.

Results: This study demonstrates reducing the storage [O₂] to reflect near physiological levels significantly alters O₂ distribution within the unit and negatively impacts platelet functionality and quality, and therefore is not a viable storage option.

Discussion: We show the reduction of platelet concentration within a unit improves O₂ availability and pH, promotes a more uniform distribution of O₂ throughout prolonged storage, and maintains platelet agonist-induced aggregation comparable to 100% platelet concentration. This may be a viable option and could potentially lead to reduced donor demand.

Background: Intravenous immunoglobulin (IVIG) therapy is used in the treatment of pediatric diseases, although data about IVIG-related adverse events (IVIG-AEs) are limited. Objectives of this study were to document the incidence of IVIG-AEs in pediatric hospitalized patients and to identify risk factors for IVIG-AEs.

Methods: This retrospective cohort study included patients <18 years old who received IVIG therapy while admitted at a Canadian pediatric tertiary care center between 2016 and 2020. Patients and IVIG-perfusions characteristics were collected, as well as IVIG-AEs. Bivariate and multivariable logistic regressions were used to explore predictors of IVIG-AEs.

Results: We included 228 children, totaling 478 IVIG perfusions. Indications included treatment for inflammatory (52.6%), autoimmune disorders (35.5%), and immunoglobulin replacement (11.8%). A total of 213 IVIG-AEs were reported. Fever (13.6%) and headache (6.7%) were the most frequent IVIG-AEs. Most IVIG-AEs were mild (57%) or moderate (31%) in severity, but 12% were severe reactions. The following factors were predictive of IVIG-AEs in univariate analyses: older age (OR 1.14 [95% CI: 1.07-1.21]), dehydration (OR 2.55 [95% CI: 1.43-4.55]), concurrent allergies (OR 2.87 [95% CI: 1.26-6.56]), first perfusion (OR 1.53 [95% CI: 1.02-2.30]), and higher dosage (OR 2.14 [95% CI: 1.39-3.33]). Concurrent steroids decreased the risk of IVIG-AEs (OR 0.43 [95% CI: 0.19-0.96]). Older age and higher IVIG dose remained independent predictors of IVIG-AEs in multivariable analyses.

Conclusions: Mild IVIG-AEs are frequent in children, and serious reactions may occur. Prospective studies are needed to confirm risk factors for IVIG-AEs and to evaluate how to best prevent them.

Background: Liberal or overtransfusion (OT) may be regarded as "inappropriate," but it is not reported as a transfusion-related adverse event. A definition of OT is lacking. OT may include overdosing of components, giving the incorrect component, or unnecessary administration without evidence of need for transfusion. OT can be associated with hypercoagulability, thrombosis, alloimmunization, increased mortality, longer hospital stay, increased infection rates, and adverse cardiocirculatory events.

Study design and methods: In 2023, an expert panel formed a hemovigilance international taskforce embedded in the German Interdisciplinary Taskforce for Clinical Hemotherapy (IAKH). The group was charged with proposing simple criteria to be used by hemovigilance systems to document instances of OT.

Results: This international initiative combined a narrative review of the literature for the rate and outcomes of OT with transfusion error reports to propose a definition for OT, including a definition for transfusion-induced hypercoagulopathy (TIH), three new codes for OT/TIH and subcodes A to G, three severity categories (serious adverse event, adverse event, near miss), and four incident codes (definite, probable, possible, not determinable). These codes can be used by hemovigilance systems to appropriately document instances of OT.

Conclusions: Global adoption of these codes within hemovigilance systems would assist with the recognition and reporting of instances of OT, promote effective policies for adequate clinical administration techniques, and support technical guidelines for avoidance of OT. Thereby, incorporation of OT into hemovigilance strategies could support adequate use of blood products, increase patient safety, and facilitate blood supply and availability.